[Senate Hearing 114-768]
[From the U.S. Government Publishing Office]
DEPARTMENT OF LABOR, HEALTH AND HUMAN SERVICES, AND EDUCATION, AND
RELATED AGENCIES APPROPRIATIONS FOR FISCAL YEAR 2015
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U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
[Clerk's note.--The subcommittee was unable to hold
hearings on departmental and nondepartmental witnesses. The
statements and letters of those submitting written testimony
are as follows:]
DEPARTMENTAL WITNESSES
Prepared Statement of the Association of Public Television Stations and
the Public Broadcasting Service
On behalf of America's 170 public television licensees, we
appreciate the opportunity to submit testimony for the record on the
importance of Federal funding for local public television stations and
PBS. We urge the Subcommittee to support level funding of $445 million
in 2-year advance funding for the Corporation for Public Broadcasting
(CPB) in fiscal year 2017, and pre-sequester level funding of $27.3
million for the Ready To Learn program at the Department of Education
in fiscal year 2015.
Corporation for Public Broadcasting--fiscal year 2017 Request: $445
million, 2-year advance funded
Local stations and PBS are committed to serving the public good in
education, public safety, creating a well-informed citizenry,
preserving and promoting American history and culture, and other
essential fields. Federal funding for CPB makes these services possible
and is deserving of continued support. The overwhelming majority of
Americans agree. In a bi-partisan Hart Research Associates/American
Viewpoint poll, nearly 70 percent of American voters, including
majorities of self-identifying Republicans, Independents, and Democrats
support continued Federal funding for public broadcasting. In addition,
polls show that Americans consider PBS to be the second most
appropriate expenditure of public funds, behind only military defense.
Over 70 percent of the Federal funding for CPB goes directly to
local stations, resulting in a nationwide system of locally owned and
controlled, trusted, community-driven and community-responsive media
entities that form an incredibly successful public-private partnership
providing unique and essential local public services.
Education
Local public television stations are America's largest classroom,
meeting their communities' lifelong education needs by providing the
highest quality educational content and resources on multiple media
platforms and in person. Public television's exceptional content,
available to nearly every household in America, has helped more than 90
million pre-school age children get ready to learn and succeed in
school.
PBS, in partnership with local public television stations, has
created PBS LearningMedia, an online portal where educators can access
more than 35,000 standards-based, curriculum-aligned interactive
digital learning objects created from public television content, as
well as material from the Library of Congress, National Archives and
other high-quality sources. More than 1.3 million teachers are
registered to use PBS LearningMedia in K-12 classrooms serving millions
of students throughout the country. In addition, twenty-eight thousand
homeschoolers use PBS LearningMedia to enrich their curriculum in
history, science, the arts and other subjects. Public television
stations also operate virtual high schools that bring high-quality
instruction in the most specialized fields to the most remote locations
in our country.
Through the American Graduate Initiative, CPB and public media
stations are working to confront the dropout crisis in America's high
schools by providing resources and services to raise awareness,
coordinate action with local community partners, and work directly with
students, parents, teachers, mentors, volunteers and leaders to lower
the drop-out rate in their respective communities. In addition, by
operating one of the most comprehensive non-profit GED programs in the
country, public television stations have helped hundreds of thousands
of second-chance students and adult learners get their high-school
equivalency certificates and prepare themselves for meaningful work in
a competitive marketplace.
Public television stations have made it a top priority to help
retrain the American workforce, including veterans, by providing
digital learning opportunities for those looking for training,
licensing, continuing education credits and more.
Partners in Public Safety
Public broadcasting stations throughout the country are also
leading innovators and irreplaceable partners to local public safety
officials--working in communities with schools, businesses and
stakeholders to provide real-time emergency support for local law
officials in times of crisis. In many communities, public broadcasting
stations are the last locally-owned and operated media outlets--serving
as a critical public safety life line.
The Nation's digital presidential alert and warning system depends
on the backbone infrastructure of local public television stations to
deliver critical national messages. This same digital infrastructure
provides the backbone for emergency alert, public safety, first
responder and homeland security services in many states and local
communities. Stations are partnering with their local emergency
responders to customize and utilize public television's infrastructure
for public safety in a variety of critical ways: equipping police cars
with school blueprints when a crisis arises, providing access to 24/7
camera feeds for a variety of security challenges, connecting public
safety agencies in real time, and more. Local public television
stations are also using their broadcast equipment to help send
emergency alert text messages to cell phone subscribers through their
providers--reaching citizens wherever they are, even when the power is
out. Many local stations are serving as their states' primary Emergency
Alert Service (EAS) hub for weather and AMBER alerts.
Supporting an Informed Citizenry
Public television strengthens the American democracy by providing
citizens with access to the history, culture and civic affairs of their
communities, their states and their country. Local public television
stations serve as the ``C-SPAN'' of many state governments, providing
the most remote corners of the country with access to the state
legislative process, Governors' messages, court proceedings and more.
As one of the only locally-owned and operated media remaining in
America, public television provides more public affairs programming,
local history, arts and culture, candidate debates, specialized
agricultural news, and citizenship information of all kinds than anyone
else in the media universe.
Public Broadcasting is a Smart Investment
All of this is made possible by the Federal funding to CPB which
amounts to an annual cost of about $1.35 per year for each American. On
average, Federal funding for CPB makes up approximately 15 percent of
local television station's budgets. However, for many smaller and rural
stations, Federal funding represents more than 30-50 percent of their
total budget. This funding is particularly important to rural stations
that struggle to raise local funds from individual donors due to the
smaller and often economically strained population base. At the same
time it is often more costly to serve rural areas due to the topography
and distances between communities. As a result, public broadcasters,
with their commitment to universal service, are often the only local
broadcaster serving rural communities. For all stations, Federal
funding is the ``lifeblood'' of public broadcasting, providing critical
seed money to local stations that enables them to build additional
support from state legislatures, private foundations and corporations,
and ``viewers like you.''
Public broadcasting creates important economic activity while
providing an essential educational and cultural service. For every
Federal dollar, local public media stations raise an additional six
dollars in non-Federal funding, providing a strong public-private
partnership and an impressive 6 to 1 return on investment. In addition,
public broadcasting supports approximately 20,000 jobs, with the vast
majority in local public television and radio stations in hundreds of
communities across America.
Two-Year Advance Funding
Two-year advance funding is essential to the mission of public
broadcasting. This longstanding practice, proposed by President Ford
and embraced by Congress in 1976, establishes a firewall insulating
programming decisions from political interference, enables the
leveraging of funds to ensure a successful public-private partnership,
and provides stations with the necessary lead time to plan in-depth
programming and curriculum coordination with educational institutions
Public television's history of editorial independence has been
rewarded in unprecedented levels of public trust--for the eleventh
consecutive year, the American people have ranked PBS as one of the
most trusted national institutions. Advance funding and the firewall it
provides between the development of content and extraneous interference
and control is vital to maintaining this credibility among the American
public.
In addition, local public broadcasting stations leverage the 2-year
advance funding to raise state, local and private funds, ensuring the
continuation of this strong public-private partnership. These Federal
funds act as essential seed money for fundraising efforts at every
station, no matter its size, and since many state legislatures are
part-time institutions that budget State funds on a 2-year cycle and
relate state funding to Federal funding, advance Federal funding is
essential to the success of this unique partnership
Finally, the 2-year advance funding mechanism also gives stations
and producers the critical lead time needed to partner with local
community organizations and plan and produce high-quality programs. The
signature series that demonstrate the depth and breadth of public
television, like Ken Burns's The Civil War, take several years to
produce. In addition, 2-year advance funding is essential to the
creation of local programming over multiple fiscal years as stations
convene the community to identify needs, recruit partners, conduct
research, develop content and deliver services.
Ready To Learn--fiscal year 2015 Request: $27.3 million (Department of
Education)
The Ready To Learn (RTL) competitive grant program uses the power
of public television's on-air, online, mobile, and on-the-ground
educational content to build the literacy and STEM skills of children
between the ages of two and eight, especially those from low-income
families. Through their RTL grant, CPB and PBS are delivering evidence-
based, innovative, high-quality transmedia content to improve the math
and literacy skills of high-need children via broadcast television, the
Internet, mobile and other dynamic new technologies. CPB and PBS, in
partnership with local stations, have been able to ensure that the kids
and families that are most in need have access to these groundbreaking
and proven effective educational resources. In addition to the content,
CPB and PBS are creating new tools like a sophisticated progress
tracking system that gives parents the means to measure student
progress, in real time.
Results
RTL is rigorously evaluated for its appeal and efficacy so the
program can continue to offer America's youngest citizens the tools
they need to succeed in school and in life. Studies show that RTL
content has a significant and positive effect on the educational lives
of children who use it. Highlights of recent studies show that: use of
PBS KIDS content and games by low-income parents and their preschool
children improves math learning and helps prepare children for entry
into kindergarten; \1\ use of RTL content has been associated with a 29
percent improvement in reading ability in children grades K-2; \2\ and
parents who used RTL math resources in the home became considerably
more involved in supporting their children's learning outcomes.\3\ In
combination, RTL games, activities and videos provide early learners
with the critical math and literacy skills needed to succeed in school,
and in the process, help level the academic playing field.
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\1\ McCarthy, B., Li, L., Schneider, S., Sexton, U., & Tiu, M.
(2013). PBS KIDS Mathematics Transmedia Suites in Preschool Homes and
Communities. A Report to the CPB-PBS Ready to Learn Initiative. Redwood
City, CA: WestEd. McCarthy, B., Li, L., Tiu, M. (2012). PBS KIDS
Mathematics Transmedia Suites in Preschool Homes. Redwood City, CA:
WestEd
\2\ Public Broadcasting Service (2012). KBTC Ready To Learn
Initiative 2012 Summary Report, pp. 15,16.
\3\ McCarthy, B., Li, L., Schneider, S., Sexton, U., & Tiu, M.
(2013). PBS KIDS Mathematics Transmedia Suites in Preschool Homes and
Communities. A Report to the CPB-PBS Ready to Learn Initiative. Redwood
City, CA: WestEd. McCarthy, B., Li, L., Tiu, M. (2012). PBS KIDS
Mathematics Transmedia Suites in Preschool Homes. Redwood City, CA:
WestEd
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An Excellent Investment
In addition to being research-based and teacher tested, the RTL
Television program also provides excellent value for our Federal
dollars. In the last 5-year grant round, public broadcasting leveraged
an additional $50 million in funding to augment the $73 million
investment by the Department of Education for content production.
Without the investment of the Federal government, this supplemental
funding would likely end.
The Dangers of Consolidation
The President's fiscal year 2015 budget proposes consolidating RTL
into a larger grant program. APTS and PBS oppose this proposal as it
would abandon the unique national-local partnership that has resulted
in RTL's ground-breaking educational impact on kids nationwide,
particularly those with limited access to other educational resources.
The current model effectively uses an economy of scale to create high-
quality television and online content at the national level and then
distribute it through local stations who can tailor outreach to the
specific needs of their communities. This model allows PBS and local
stations to annually reach 80 percent of America's children ages 2 to 8
through television and another 13 million per month online and on
mobile apps. The national-local partnership has made RTL tremendously
efficient and effective and consolidation or elimination of the program
would severely affect the ability of local stations to respond to their
communities' educational needs, eliminating the critical resources
provided by this program for children, parents and teachers. RTL
symbolizes the mission of public media and is a successful public-
private partnership that leverages Federal funds to create the most
appealing and impactful children's educational content that is
supplemented by online and on-the-ground resources. Without the RTL
program, millions of families would lose access to this incredible
high-quality education content, especially the low-income and
underserved households that are a particular focus of this program.
Conclusion
Americans across the political spectrum rely on public
broadcasting--on television, on the radio, online, and in the
classroom--because we provide essential education, public safety, and
informed citizenry services that are not available anywhere else. And
none of this would be possible without the Federal investment in public
broadcasting. A 2007 GAO report concluded that these Federal Community
Service Grants are an irreplaceable source of revenue for public
broadcasting, and a 2012 study requested by this Subcommittee and
conducted by an independent third party for CPB came to the same
conclusion as the GAO: Federal funding for public broadcasting is
irreplaceable.
For all of these reasons we request that Congress continue its
commitment to the highly successful, hugely popular public-private
partnership that is public broadcasting by providing level funding of
$445 million in fiscal year 2017 for the 2-year advance of the
Corporation for Public Broadcasting and pre-sequester level funding of
$27.3 million in fiscal year 2015 for the stand alone Ready To Learn
Program.
______
Prepared Statement of the National Public Radio
Dear Chairman Harkin, Ranking Member Moran and Members of the
Subcommittee: Thank you for this opportunity to urge the Subcommittee's
support for an annual Federal investment of $445 million in America's
public media system through annual appropriations to the Corporation
for Public Broadcasting (CPB). With your support, the public radio
system, consisting of some 950 locally managed, locally controlled and
locally programmed stations, serves communities all across America. And
these stations are as diverse as the communities they represent. Public
radio is committed to being America's public radio, bringing the
diverse and changing voices of Americans to the airwaves and the new
platforms that so many Americans are using. We strive to create a more
informed public, one challenged and invigorated by a deeper
understanding and appreciation of events, ideas, and culture within the
United States and across the globe.
The public radio system, a uniquely American public service, non-
commercial, media enterprise, includes stations in every State capitol
and hundreds of American communities, large and small, urban and rural.
Producers and distributors of public radio programming, including
American Public Media (APM), Public Radio International (PRI), the
Public Radio Exchange (PRX) and NPR are united by a commitment to the
highest standards of journalist ethics. Every minute of every program
broadcast to some 38 million Americans weekly is routed through the
Public Radio Satellite System (PRSS), a content distribution utility
owned by the public radio system.
Partnerships and collaborations are integral components of the
programming and service found in the public radio system. Available on
air, online, and on new and emerging mobile platforms, public radio is
expanding its ability to reach audiences. And as traditional media
undergoes dramatic changes, public radio is positioning itself to serve
the needs of a growing audience in a shifting media landscape and
rapidly changing world.
A clear example of these new adaptations to improve journalism and
meet audience needs comes from the recently formed merger between St.
Louis Public Radio and the St. Louis Beacon newspaper, the area's two
largest nonprofit news organizations. This move combines newsrooms and
significantly changes the face of independent local news in the region
by providing more depth and perspective on issues and stories that
impact the community. The consolidation creates an innovative model for
a multiplatform news operation that results in more in-depth coverage
of urban events and issues. St. Louis Public Radio's move to join
forces and expand serves as an example of how public radio news
organizations are adjusting to an ever-changing media environment that
involves greater competition for consumers and financial support.
This new merger is just one among a growing list of public
broadcasters teaming up with other nonprofit news outlets to beef up
their local and investigative journalism. In Denver, Rocky Mountain
PBS, public radio station KUVO, and I-News, the Rocky Mountain
Investigative News Network, merged to create a cross-platform news
operation that could better cover Colorado. WWNO in New Orleans hired
its first-ever news director last spring to expand its coverage of
stories. Oregon Public Broadcasting is building a statewide news
network with 40 to 50 small news outlets across Oregon. Lastly, Harvest
Public Media, a reporting collaboration of public radio stations KCUR,
KBIA, Iowa Public Radio, Nebraska Public Broadcasting, KUNC and WUIS,
focuses on issues of food, fuel and field. Based at KCUR in Kansas
City, Harvest covers these agriculture-related topics through an
expanding network of reporters and partner stations throughout the
Midwest.
But the partnerships don't stop there for public radio. A recent
collaboration includes Boston's WBUR and NPR joining forces to expand
and re-launch the daily public radio show Here & Now as a two-hour
national news program for audiences in the middle of the day. The
program airs weekday afternoons and is aggressively updated to provide
local audiences with live, updated news coverage during mid-day.
Public radio's partnerships with public safety officials play a
critically important role when natural or man-made disasters strike.
Public radio stations provide essential and timely public emergency
information, such as evacuation routes, shelter locations and severe
weather updates. Effective emergency warnings allow people to take
actions that save lives, and reduce damage and human suffering. Federal
funding helps to bring crucial news and alerts to millions of
Americans.
Public radio's innovative partnerships also expand our public
service mission by enabling radio reception to all Americans during
local emergency situations. This year, 26 public radio stations based
in Alabama, Florida, Louisiana, Mississippi and Texas are working with
NPR Labs, the Public Radio Satellite System (PRSS) and the U.S.
Department of Homeland Security/FEMA to demonstrate the delivery of
emergency alerts to people who are deaf or hard-of-hearing. This is the
first effort to deliver real-time accessibility-targeted emergency
messages, such as weather alerts, via radio broadcast texts. Our hope
is to expand the pilot over time to other regions of our country thru
the use of radio equipment to reach people who are both deaf and blind
and non-English speaking.
In addition, many public radio stations provide critical services
through partnerships with radio reading services. These long
established centers are in every major market in the United States to
provide millions of visually impaired persons the ability to function
more independently in their communities.
Music in America would sound very different without public radio.
Local stations take creative risks, nurture new talent, and give
emerging artists a chance to be heard. They celebrate traditional music
genres like classical and jazz, and partner with local music
organizations to take these art forms to new heights of performance
excellence and new audiences. And they play a key role in their local
music economies, sustaining and growing the careers of musicians by
connecting them to local listeners. Across the country, more than 180
local public radio stations have full-time music formats and more than
650 stations air play music as part of their programming lineups.
Mr. Chairman and Senator Moran, public radio is essential in
providing news, information and cultural programming to America and
connecting with audiences wherever they are. We're embracing America's
changing demographics and using digital media to connect better, more
quickly and in more diverse ways. Today's public radio isn't going
away, it's going everywhere and we are working every day to earn the
trust of the 38 million Americans who rely on us for news and insights
that guide and inform. We ask for your continuing support in funding
for stations that serve your communities, your constituents and
America's Democracy.
[This statement was submitted by Michael Riksen, Vice President--
Policy & Representation, National Public Radio.]
______
Prepared Statement of the Railroad Retirement Board
Ms. Chairwoman and Members of the Committee: We are pleased to
present the following information to support the Railroad Retirement
Board's (RRB) fiscal year 2015 budget request of $112,150,000 for our
retirement, unemployment and other programs.
The RRB administers comprehensive retirement/survivor and
unemployment/sickness insurance benefit programs for railroad workers
and their families under the Railroad Retirement and Railroad
Unemployment Insurance Acts. The RRB also has administrative
responsibilities under the Social Security Act for certain benefit
payments and Medicare coverage for railroad workers. The RRB has also
administered special economic recovery payments and extended
unemployment benefits under the American Recovery and Reinvestment Act
of 2009 (Public Law 111-5) and extended unemployment benefits under the
Worker, Homeownership, and Business Assistance Act of 2009 (Public Law
111-92). More recently, we have administered extended unemployment
benefits under the Tax Relief, Unemployment Insurance Reauthorization,
and Job Creation Act of 2010 (Public Law 111-312), the Temporary
Payroll Tax Cut Continuation Act of 2011 (Public Law 112-78), the
Middle Class Tax Relief and Job Creation Act of 2012 (Public Law 112-
96) and the American Taxpayer Relief Act of 2012 (Public Law 112-240).
During fiscal year 2013, the RRB paid $11.7 billion, net of
recoveries, in retirement/survivor benefits to about 568,000
beneficiaries. We also paid $84.5 million in net unemployment/sickness
insurance benefits to more than 26,000 claimants. Temporary extended
unemployment benefits paid were $6.8 million. In addition, the RRB paid
benefits on behalf of the Social Security Administration amounting to
$1.4 billion to about 113,000 beneficiaries.
proposed funding for agency administration
The President's proposed budget would provide $112,150,000 for
agency operations, which would enable us to maintain a staffing level
of 860 full-time equivalent staff years (FTEs) in 2015. The proposed
budget would also provide $2,500,000 for information technology (IT)
investments for the conversion of a legacy Program Accounts Receivable
(PAR) system to a modern accounts receivable module within our cloud-
based core financial system that was implemented October 1, 2013.
agency staffing
The RRB's dedicated and experienced workforce is the foundation for
our tradition of excellence in customer service and satisfaction. Like
many Federal agencies, however, the RRB has a number of employees at or
near retirement age. About 63 percent of our employees have 20 or more
years of service, and over 28 percent of our current workforce will be
eligible for retirement by fiscal year 2015. As we continue to
modernize our information technology infrastructure to automate and
convert manual workloads, our agency will also improve training
delivery and reporting within our workforce. We plan to acquire and
implement a Learning Management System that will provide a
comprehensive functionality for training administration, documentation,
tracking, reporting and delivery of e-learning education and training
programs. This will allow the agency to improve all aspects involved in
the learning process to meet our human capital needs as we experience a
high rate of change in personnel. Furthermore, we will complement this
initiative by implementing an executive training program to prepare and
mentor future agency leaders that are ready to replace a significant
number of senior leaders within the agency that are eligible to retire.
In connection with these workforce planning efforts, the
President's budget request includes a legislative proposal to enable
the RRB to utilize various hiring authorities available to other
Federal agencies. Section 7(b) (9) of the Railroad Retirement Act
contains language requiring that all employees of the RRB, except for
one assistant for each Board Member, must be hired under the
competitive civil service. We propose to eliminate this requirement,
thereby enabling the RRB to use various hiring authorities offered by
the Office of Personnel Management. Also, our budget request includes a
legislative proposal to clarify the authority of the Railroad
Retirement Board to retain in the competitive civil service attorneys
hired prior to a change in OPM policy in 2013.
information technology improvements
We are actively pursuing further automation and modernization of
the RRB's various processing systems to support the agency's mission to
administer benefit programs for railroad workers and their families. In
fiscal year 2015, funding is included for contractor support to
complete the full design of the Financial Management Integrated System
(FMIS) by migrating a benefit payment feeder system named Program
Accounts Receivable (PAR) to FMIS. FMIS migration from an obsolete
financial system was started Oct 1, 2012 and completed Oct 1, 2013. Due
to reduction in funds of the FMIS program during the sequestered fiscal
year, PAR migration into FMIS was delayed. Once completed, the PAR
migration to FMIS will enhance the processing of debt transactions for
improper benefit payments in an integrated financial system hosted in a
cloud environment. We expect PAR migration to FMIS to reduce staffing
requirements and improve efficiency of the improper payment process.
other requested funding
The President's proposed budget includes $34 million to fund the
continuing phase-out of vested dual benefits, plus a 2 percent
contingency reserve, $680,000, which ``shall be available proportional
to the amount by which the product of recipients and the average
benefit received exceeds the amount available for payment of vested
dual benefits.'' In addition, the President's proposed budget includes
$150,000 for interest related to uncashed railroad retirement checks.
financial status of the trust funds
Railroad Retirement Accounts--The RRB coordinates its financial
needs with the National Railroad Retirement Investment Trust (Trust),
the Trust was established by the Railroad Retirement and Survivors'
Improvement Act of 2001 (RRSIA) to manage and invest railroad
retirement assets. Pursuant to the RRSIA, the RRB has transferred a
total of $21.276 billion to the Trust. All of these transfers were made
in fiscal years 2002 through 2004. The Trust has invested the
transferred funds, and the results of these investments are reported to
the RRB and posted periodically on the RRB's website. Through December
2013, the Trust had transferred approximately $15.4 billion to the
Railroad Retirement Board for payment of railroad retirement benefits.
The net asset value of Trust-managed assets on September 30, 2013, was
approximately $25.0 billion, an increase of almost $1.4 billion from
the previous year.
In June 2012, we released the 25th Actuarial Valuation of the
railroad retirement system required by Sections 15(g) of the Railroad
Retirement Act of 1974. That report also met the requirements of
Section 22 of the Railroad Retirement Act of 1974, and Section 502 of
the Railroad Retirement Solvency Act of 1983. The report addressed the
75-year period 2011-2085, including projections of the status of the
retirement trust funds under three employment assumptions. It concluded
that barring a sudden, unanticipated, large decrease in railroad
employment or substantial investment losses, the railroad retirement
system would experience no cash flow problems for the next 23 years.
Even under the most pessimistic assumption, the cash flow problems
would not occur until the year 2035. The report did not recommend any
change in the rate of tax imposed by current law on employers and
employees.
The RRB's latest annual report required by Section 502 of the
Railroad Retirement Solvency Act of 1983 was released in June 2013. The
overall conclusion was that barring a sudden unanticipated, large
decrease in railroad employment or substantial investment losses, the
railroad system will experience no cash flow problems during the next
25 years.
Railroad Unemployment Insurance Account--The RRB's latest annual
report on the financial status of the railroad unemployment insurance
system was issued in June 2013. The report indicated that even as
maximum daily benefit rates will rise approximately 42 percent (from
$66 to $94) from 2012 to 2023, experience-based contribution rates are
expected to keep the unemployment insurance system solvent, except for
small, short-term cash-flow problems in 2015 and 2016 under the most
pessimistic assumption. However, projections show quick repayment of
any loans by the end of each fiscal year.
Unemployment levels are the single most significant factor
affecting the financial status of the railroad unemployment insurance
system. However, the system's experience-rating provisions, which
adjust contribution rates for changing benefit levels, and its
surcharge trigger for maintaining a minimum balance, help to ensure
financial stability in the event of adverse economic conditions. No
financing changes were recommended at this time by the report.
Thank you for your consideration of our budget request. We will be
happy to provide further information in response to any questions you
may have.
[This statement was submitted by Michael S. Schwartz, Chairman,
Walter A. Barrows, Labor Member, and Jerome F. Kever, Management
Member, Railroad Retirement Board.]
______
Prepared Statement of the Inspector General, Railroad Retirement Board
Mr. Chairman and Members of the Subcommittee: My name is Martin J.
Dickman, and I am the Inspector General for the Railroad Retirement
Board. I would like to thank you, Mr. Chairman, and the members of the
Subcommittee for your continued support of the Office of Inspector
General.
budget request
The President's proposed budget for fiscal year 2015 would provide
$8,750,000 to the Office of Inspector General (OIG) to ensure the
continuation of the OIG's independent oversight of the Railroad
Retirement Board (RRB). During fiscal year 2015, the OIG will focus on
areas affecting program performance; the efficiency and effectiveness
of agency operations; and areas of potential fraud, waste and abuse.
operational components
The OIG has three operational components: the immediate Office of
the Inspector General, the Office of Audit (OA), and the Office of
Investigations (OI). The OIG conducts operations from several
locations: the RRB's headquarters in Chicago, Illinois; an
investigative field office in Philadelphia, Pennsylvania; and five
domicile investigative offices located in Virginia, Texas, California,
Florida, and New York. These domicile offices provide more effective
and efficient coordination with other Inspector General offices and
traditional law enforcement agencies, with which the OIG works joint
investigations.
office of audit
The mission of the Office of Audit (OA) is to promote economy,
efficiency, and effectiveness in the administration of RRB programs and
detect and prevent fraud and abuse in such programs. To accomplish its
mission, OA conducts financial, performance, and compliance audits and
evaluations of RRB programs. In addition, OA develops the OIG's
response to audit-related requirements and requests for information.
During fiscal year 2015, OA will focus on areas affecting program
performance; the efficiency and effectiveness of agency operations; and
areas of potential fraud, waste, and abuse. OA will continue its
emphasis on long-term systemic problems and solutions, and will address
major issues that affect the RRB's service to rail beneficiaries and
their families. OA has identified four broad areas of potential audit
coverage: Financial Accountability; Railroad Retirement Act and
Railroad Unemployment Insurance Act Benefit Program Operations;
Railroad Medicare Program Operations; and Security, Privacy, and
Information Management. OA must also accomplish the following mandated
activities with its own staff: Audit of the RRB's financial statements
pursuant to the requirements of the Accountability of Tax Dollars Act
of 2002, evaluation of information security pursuant to the Federal
Information Security Management Act (FISMA), and an audit of the RRB's
compliance with the Improper Payments Elimination and Recovery Act of
2010.
During fiscal year 2015, OA will complete the audit of the RRB's
fiscal year 2014 financial statements and begin its audit of the
agency's fiscal year 2015 financial statements. OA contracts with a
consulting actuary for technical assistance in auditing the RRB's
``Statement of Social Insurance'', which became basic financial
information effective in fiscal year 2006. In addition to performing
the annual evaluation of information security, OA also conducts audits
of individual computer application systems which are required to
support the annual FISMA evaluation. Our work in this area is targeted
toward the identification and elimination of security deficiencies and
system vulnerabilities, including controls over sensitive personally
identifiable information.
OA undertakes additional projects with the objective of allocating
available audit resources to areas in which they will have the greatest
value. In making that determination, OA considers staff availability,
current trends in management, Congressional and Presidential concerns.
office of investigations
The Office of Investigations (OI) focuses its efforts on
identifying, investigating, and presenting cases for prosecution,
throughout the United States, concerning fraud in RRB benefit programs.
OI conducts investigations relating to the fraudulent receipt of RRB
disability, unemployment, sickness, and retirement/survivor benefits.
OI investigates railroad employers and unions when there is an
indication that they have submitted false reports to the RRB. OI also
conducts investigations involving fraudulent claims submitted to the
Railroad Medicare Program. These investigative efforts can result in
criminal convictions, administrative sanctions, civil penalties, and
the recovery of program benefit funds.
OI INVESTIGATIVE RESULTS FOR FISCAL YEAR 2013
------------------------------------------------------------------------
Indictments/ Recoveries/
Civil Judgments Informations Convictions Receivables
------------------------------------------------------------------------
37 47 81 \1\ $414,254,000
------------------------------------------------------------------------
\1\ This total includes the results of joint investigations with other
agencies.
OI anticipates an ongoing caseload of about 400 investigations in
fiscal year 2015. During fiscal year 2013, OI opened 156 new cases and
closed 238. At present, OI has cases open in 48 States, the District of
Columbia, and Canada with estimated fraud losses of nearly $217
million. Disability fraud cases represent the largest portion of Ol's
total caseload. These cases involve more complicated schemes and often
result in the recovery of substantial amounts for the RRB's trust
funds. They also require considerable resources such as travel by
special agents to conduct surveillance, numerous witness interviews,
and more sophisticated investigative techniques. Additionally, these
fraud investigations are extremely document-intensive and require
forensic financial analysis.
Of particular significance is an ongoing disability fraud
investigation in New York. To date, 33 individuals have been indicted;
28 of these have pleaded guilty and five more were convicted in Federal
court. In addition, 44 former railroad employees avoided prosecution by
admitting their role in the fraud and agreeing to the termination of
their benefits. OI agents will likely have to spend a substantial
amount of time traveling to New York for continuing investigations and
trial preparation in fiscal year 2015.
During fiscal year 2015, OI will continue to coordinate its efforts
with agency program managers to address vulnerabilities in benefit
programs that allow fraudulent activity to occur and will recommend
changes to ensure program integrity. OI plans to continue proactive
projects to identify fraud matters that are not detected through the
agency's program policing mechanisms.
conclusion
In fiscal year 2015, the OIG will continue to focus its resources
on the review and improvement of RRB operations and will conduct
activities to ensure the integrity of the agency's trust funds. This
office will continue to work with agency officials to ensure the agency
is providing quality service to railroad workers and their families.
The OIG will also aggressively pursue all individuals who engage in
activities to fraudulently receive RRB funds. The OIG will continue to
keep the Subcommittee and other members of Congress informed of any
agency operational problems or deficiencies.
[This statement was submitted by Martin J. Dickman, Inspector
General, Railroad Retirement Board.]
______
NONDEPARTMENTAL WITNESSES
Prepared Statement of the Academy of Nutrition and Dietetics
Dear Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies:
The Academy of Nutrition and Dietetics appreciates the opportunity
to submit testimony for the fiscal year 2015 appropriations. The
Academy is the world's largest organization of food and nutrition
professionals, and is committed to improving the Nation's health with
nutrition services and interventions provided by registered dietitian
nutritionists. Nationwide, The Academy has over 75,000 members.
As Congress begins work on fiscal year 2015 appropriations, we
strongly urge you to fully fund Federal nutrition programs that will
provide a return on investment to improve health. Investment in these
programs through the appropriations process will help prevent costly
healthcare expenses due to chronic diseases.
Senior Nutrition Funding: Administration for Community Living (ACL)
The congregate and home-delivered (commonly known as Meals on
Wheels) senior nutrition programs, the Native American Nutrition
Program, and the Nutrition Services Incentive Program (NSIP) are the
largest and most visible components of the Older Americans Act. We
strongly believe that the funding levels for the senior nutrition
programs under the Administration for Community Living must be
adequate, as these programs are key to keeping this population
independent and in their homes. The President's budget proposes no
increase for the senior nutrition programs in fiscal year 2015, yet we
know that fuel and food costs--primary costs borne by senior nutrition
programs--continue to increase. This is extremely alarming as these
programs ensure that vulnerable older adults can continue to receive
cost-effective nutrition services, ultimately saving Medicare and
Medicaid dollars. Due to an ever-increasing demand for services, even
flat funding will result in several million fewer home-delivered and
congregate meals served, which could lead to more expensive
hospitalizations or a need for long term care for older adults who
cannot safely prepare meals themselves.
The Academy strongly supports the President's fiscal year 2015
request for $20 million for Preventive Health Services under the Older
Americans Act. This program provides grants to States and Territories
to support activities that educate older adults about the importance of
health lifestyles and promotes healthy behaviors that can help to
prevent or delay chronic disease and disability, thereby reducing the
need for costly medical interventions.
The Academy also supports the Administration's proposal for
standalone funding of $8 million for Chronic Disease Self-Management
Programs (CDSMP) in the Administration for Community Living. CDSMP is a
low-cost, evidence-based disease prevention model that utilizes state-
of-the-art techniques to help older Americans with chronic diseases
better manage their conditions and improve their health status, thus
reducing their need for more costly medical care such as hospital care
and hospital readmissions. According to the National Center for Chronic
Disease Prevention and Promotion, seven out of ten deaths and more than
three-quarters of all health expenditures for older adults are the
result of preventable chronic conditions such as diabetes, obesity,
cancer, arthritis and depression.
In addition, the Academy supports the President's fiscal year 2015
request for $25 million in funding for the Elder Justice Act. Cases of
elder abuse, neglect and exploitation are on the rise in this country;
recent studies estimate that 14.1 percent of older adults face some
sort of abuse, and another study estimates seniors lose a minimum of
$2.5 billion each year as a result (MetLife and the National Committee
for the Prevention of Elder Abuse). Elder abuse is a major threat to
the health of our elderly population.
Centers for Disease Control and Prevention (CDC) Funding
The Academy respectfully requests adequate funding for CDC's fiscal
year 2015 ``core programs.'' We strongly believe that the activities
and programs supported by CDC are essential to protect the health of
the American people. CDC is faced with enormous challenges and
responsibilities, from bioterrorism preparedness to chronic disease
prevention and eliminating health disparities. In addition, CDC funds
effective community programs including health promotion efforts and
nutrition interventions that help prevent heart and lung disease,
cancer, diabetes, stroke, and other chronic diseases. More than 70
percent of CDC's budget supports State and local health organizations
and academic institutions.
We support the President's budget proposal to reduce chronic
diseases through diabetes funding totaling $140 million and heart
disease funding totaling $130 million. These expenditures will help
reduce the heavy healthcare cost burden of these two diseases.
We also ask that you maintain the fiscal year 2014 funding of $8
million (not the reduced level in the fiscal year 2015 President's
Request) for Hospitals Promoting Breastfeeding. According to the CDC,
childhood obesity is an epidemic. One in five preschoolers in our
country is overweight, and half of these are obese. A baby's risk of
becoming an overweight child is reduced with each month that the baby
is breastfed. In the US, most babies start breastfeeding, but within
the first week, half have already been given formula, and by 9 months,
only 31 percent of babies are breastfeeding at all. Hospitals play a
critical role in encouraging new moms to breastfeed.
Food and Drug Administration (FDA) Funding
The Academy supports the President' budget of $1.48 billion for
food safety. A robust food safety system and the continued
implementation of the Food Safety Modernization Act will help reduce
food-borne illness that costs the U.S. healthcare system $88 billion
annually.
Again, thank you for reviewing these comments and please feel free
to contact us for any additional information.
[This statement was submitted by Mary Pat Raimondi MS, RD, Vice
President, Strategic Policy and Partnerships Academy of Nutrition and
Dietetics.]
______
Prepared Statement of AcademyHealth
AcademyHealth is pleased to offer this testimony regarding funding
for Federal agencies that support health services research and health
data, including the Agency for Healthcare Research and Quality (AHRQ),
the National Center for Health Statistics (NCHS), and the National
Institutes of Health (NIH). AcademyHealth's mission is to support
research that leads to accessible, high value, high-quality healthcare;
reduces disparities; and improves health. We represent the interests of
more than 5,000 scientists and policy experts and 180 organizations
that produce and use health services research to improve our Nation's
health and the performance of the healthcare and public health systems.
For fiscal year 2015, we recommend funding levels of $375 million for
AHRQ, $182 million for NCHS, and $32 billion for NIH.
The United States spent $2.8 trillion--17.2 percent of our
economy--on healthcare in 2012. Finding new ways to get the most out of
every healthcare dollar is critical to our Nation's long-term fiscal
health. Like any corporation making sure it is developing and providing
high quality products, the Federal Government--as the Nation's largest
healthcare purchaser--has a responsibility to get the most value out of
every taxpayer dollar it spends on Medicare, Medicaid, Children's
Health Insurance Program, and veterans' and service members' health.
Health services research is our Nation's R&D enterprise for health
improvement. Just as medical research discovers cures for disease,
health services research discovers cures for the health system (see
Figure 1). This research diagnoses problems in healthcare and public
health delivery and identifies solutions to improve outcomes for more
people, at greater value. And while biomedical and clinical research
discoveries can take years and even decades to reach patients,
discoveries from health services research can be used now by patients,
healthcare providers, public health professionals, hospitals,
employers, and public and private payers to improve care today.
Put plainly, health services research helps Americans get their
money's worth when it comes to healthcare. We need more of it, not
less. Despite the positive impact health services research has had on
the U.S. healthcare system, and the potential for future improvements
in quality and value, the United States spends less than one cent of
every healthcare dollar on this research; research that can help
Americans spend their healthcare dollars more wisely and make more
informed healthcare choices.
AcademyHealth realizes the pressure Congress and the administration
face to reduce the national debt. We respectfully ask that the
subcommittee consider the value of health services research in
achieving that goal, and to strengthen its capacity to address the
pressing challenges America faces in providing access to high-quality,
efficient care. The following list summarizes AcademyHealth's fiscal
year 2015 funding recommendations for agencies that support health
services research and health data under the subcommittee's
jurisdiction.
Agency for Healthcare Research and Quality
AHRQ is the only Federal research agency with the sole purpose of
producing evidence to make healthcare safer; higher quality; more
accessible, equitable, and affordable; and to ensure that the evidence
is understood and used. AHRQ funds health services research and
healthcare improvement programs in universities, medical centers,
research institutions, hospitals, health clinics, and medical practices
that are transforming people's health in communities in every State
around the Nation. The science funded by AHRQ provides consumers and
their healthcare professionals with valuable evidence to make
healthcare decisions. For example, medical societies use AHRQ-funded
research to inform their recommendations for treatment of type 2
diabetes and rheumatoid arthritis. These evidence-informed
recommendations give physicians a foundation for describing what the
best care looks like, so millions of patients living with these and
other conditions may determine what the right care might be for them.
AHRQ's research also provides the basis for strategies that prevent
medical errors, reduce hospital-acquired infections (HAI), and improve
patient experiences and outcomes. For example, AHRQ's evidence-based
Comprehensive Unit-based Safety Program to Prevent Healthcare-
Associated Infections (CUSP)--first applied on a large scale in 2003
across more than 100 ICUs across Michigan--saved more than 1,500 lives
and nearly $200 million in the program's first 18 months. The protocols
have since been expanded to hospitals in all 50 States, the District of
Columbia, and Puerto Rico to continue the national implementation of
this approach for reducing HAIs.
AcademyHealth joins the Friends of AHRQ--an alliance of health
professional, research, consumer, and employer organizations that
support the agency--in recommending a base discretionary funding level
of $375 million for AHRQ in fiscal year 2015.
National Center for Health Statistics
NCHS is the Nation's principal health statistics agency. Housed
within the Centers for Disease Control and Prevention (CDC), it
provides critical data on all aspects of our healthcare system through
data cooperatives and surveys that serve as a gold standard for data
collection around the world. AcademyHealth appreciates the
subcommittee's support of NCHS in recent years. Such efforts have
allowed NCHS to reinstate data collection and quality control efforts,
continue the collection of vital statistics, and modernize surveys to
reflect changes in demography, geography, and health delivery.
We join the Friends of NCHS--an alliance of health professional,
research, consumer, industry, and employer organizations that support
the agency--in recommending an overall funding level of $182 million
for NCHS in fiscal year 2015. This funding level will support the
agency's core data collection activities, as well as new initiatives to
enhance death data timeliness and security, restore survey expansions
to better assess access to and utilization of healthcare services, and
determine ``what works'' in the organization, financing, and delivery
of public health services.
National Institutes of Health
NIH spends approximately $1 billion on health services research
annually--roughly 3 percent of its entire budget--making it the largest
Federal sponsor of health services research. We join the research
community in seeking at least $32 billion for NIH in fiscal year 2015.
NIH has an important role in the Federal health services research
continuum, and is well-positioned to ensure that discoveries from
clinical trials are effectively translated into healthcare delivery.
AcademyHealth supports efforts to help NIH foster greater coordination
of its health services research investment among its institutes and
across other Federal agencies to avoid duplication.
AcademyHealth also recommends that the Clinical and Translational
Science Awards (CTSA) through the National Center for Advancing
Translational Sciences (NCATS) sustain investment in the full spectrum
of translational research (T1-T4). The CTSA program enables innovative
research teams to speed discovery and advance science aimed at
improving our Nation's health. The program encourages collaboration in
solving complex health and research challenges and finding ways to turn
their discoveries into practical solutions for patients. Finally,
AcademyHealth supports continued investment by NIH and its many
Institutes and Centers in dissemination and implementation research.
This research helps us understand which approaches work to improve
population health.
In conclusion, the accomplishments of the field of health services
research would not be possible without the leadership and support of
this subcommittee. We hope the subcommittee gives strong consideration
to our fiscal year 2015 funding recommendations for the Federal
agencies funding health services research and health data. If you have
questions or comments about this testimony or wish to know more about
health services research, please contact Dr. Lisa Simpson, President
and CEO of AcademyHealth or lisa.simpson@academyhealth.org.
FIGURE 1: THE HEALTH RESEARCH CONTINUUM
------------------------------------------------------------------------
------------------------------------------------------------------------
These components of the health research continuum work in concert, and
each plays an essential role--any one type of research on its own
cannot effectively or appreciably improve health. Take heart disease as
one example ...
------------------------------------------------------------------------
Basic research Clinical research Population-based Health services
discovered the determined which research research
contributions of treatments were identified determined how
elevated blood safe and strategies to to best deploy
pressure, effective to reduce the these
elevated treat risks of heart discoveries to
cholesterol, and hypertension, disease in achieve the
tobacco use to hypercholesterol communities best health
heart disease. emia, tobacco through non- outcomes. This
addiction, and medical research helped
to prevent and interventions, identify who
treat heart such as had the least
disease, in reduction of access, what
general. trans fats in barriers
food and existed, and
tobacco control how to mitigate
measures to them. This
reduce smoking. research also
led to the
development of
quality
measures that
are now used to
report on the
quality of
cardiac care.
------------------------------------------------------------------------
Source: AHRQ: 15 Years of Transforming Care and Improving Health,
AcademyHealth, Jan. 2014. Available at: http://academyhealth.org/files/
AHRQReport2014.pdf.
[This statement was submitted by Dr. Lisa Simpson, President & CEO,
AcademyHealth.]
______
Prepared Statement of the Ad Hoc Group for Medical Research
The Ad Hoc Group for Medical Research is a coalition of patient and
voluntary health groups, medical and scientific societies, academic and
research organizations, and industry. We appreciate the opportunity to
submit this statement in support of enhancing the Federal investment in
biomedical, behavioral, social, and population-based research conducted
and supported by the National Institutes of Health (NIH).
The Consolidated Appropriations Act of 2014 included a welcome and
much needed increase for the NIH. However, this increase did not
restore all of the funds cut by sequestration in fiscal year 2013 or
the purchasing power NIH has lost over the past decade due to
inflation. We hope fiscal year 2014 represents a first step toward
restoring our Nation's preeminence in medical research.
The Ad Hoc Group for Medical Research recommends that NIH receive
at least $32 billion in fiscal year 2015 as the next step toward a
multi-year increase in our Nation's investment in medical research. The
Ad Hoc Group also urges Congress and the Administration to work in a
bipartisan manner to end sequestration and the continued cuts to
medical research that squander invaluable scientific opportunities,
discourage young scientists, threaten medical progress and continued
improvements in our Nation's health, and jeopardize our economic
future.
The Ad Hoc Group is deeply grateful to the Subcommittee for its
long-standing and bipartisan leadership in support of NIH. We continue
to believe that science and innovation are essential if we are to
continue to improve our Nation's health, sustain our leadership in
medical research, and remain competitive in today's global information
and innovation-based economy.
NIH: A Public-Private Partnership to Save Lives and Provide Hope
The partnership between NIH and America's scientists, medical
schools, teaching hospitals, universities, and research institutions is
a unique and highly-productive relationship, leveraging the full
strength of our Nation's research enterprise to foster discovery,
improve our understanding of the underlying cause of disease, and
develop the next generation of medical advancements. Approximately 84
percent of the NIH's budget goes to more than 300,000 research
positions at over 2,500 universities and research institutions located
in every state.
The Federal Government has an irreplaceable role in supporting
medical research. No other public, corporate or charitable entity is
willing or able to provide the broad and sustained funding for the
cutting edge research necessary to yield new innovations and
technologies of the future.
Research funded by NIH has contributed to nearly every medical
treatment, diagnostic tool, and medical device developed in modern
history, from a new treatment for cystic fibrosis to an awareness
campaign that resulted in a dramatic decrease in the number of infants
lost to Sudden Infant Death Syndrome to a new vaccine to prevent
cervical cancer. We are all enjoying longer, healthier lives thanks to
the Federal government's wise investment in this lifesaving agency.
Examples of recent clinical breakthroughs made by NIH-supported
scientists include:
--NIH-funded researchers have discovered a way to harness the body's
own immune system to fight cancer. The promising results in
both adults and children with leukemia lead Science Magazine to
name Cancer Immunotherapy as the 2013 Breakthrough of the Year
for all of science;
--NIH scientists have developed new treatments for hepatitis C--the
leading reason for liver transplants in the U.S.--that have
shortened treatment times and produced cures in 85 to 95
percent of patients, even those with advanced disease;
--NIH-funded researchers found that certain molecules in urine can
provide an early sign of kidney transplant rejection, a test
that allows doctors to act earlier to protect transplanted
kidneys;
--An NIH-supported clinical trial demonstrated that an intensive
early behavioral intervention delivered before the age of 2
years can improve symptoms as well as normalize brain activity
in some children with autism; and
--NIH-funded scientists developed an innovative method to quickly
identify antibiotics that can treat multidrug-resistant
bacteria--and reveal how these bacteria-killing medications
work.
For patients and their families, NIH is the ``National Institutes
of Hope.''
NIH is the world's premier supporter of merit-reviewed,
investigator-initiated basic research. This fundamental understanding
of how disease works and insight into the cellular, molecular, and
genetic processes underlying life itself, including the impact of
social environment on these processes, underpin our ability to conquer
devastating illnesses. The application of the results of basic research
to the detection, diagnosis, treatment, and prevention of disease is
the ultimate goal of medical research. Ensuring a steady pipeline of
basic research discoveries while also supporting the translational
efforts absolutely necessary to bring the promise of this knowledge to
fruition requires a sustained investment in NIH.
The research supported by NIH drives not only medical progress but
also local and national economic activity, creating skilled, high-
paying jobs and fostering new products and industries. According to a
report released by United for Medical Research, a coalition of
scientific advocates, institutions and industries, in fiscal year 2011,
NIH-funded research supported an estimated 432,000 jobs all across the
United States, enabled 13 states to experience job growth of more than
10,000 jobs, and generated more than $62 billion in new economic
activity.
Stagnant Funding Threatens Scientific Momentum
Despite the increase provided in the current year, over the past
decade NIH has lost more than 22 percent of its budget after inflation,
significantly impacting the Nation's ability to sustain the scientific
momentum that has contributed so greatly to our Nation's health and our
economic vitality. The leadership and staff at NIH and its Institutes
and Centers has engaged patient groups, scientific societies, and
research institutions to identify emerging research opportunities and
urgent health needs, and has worked resolutely to prioritize precious
Federal dollars to those areas demonstrating the greatest promise. But
a continued erosion of our national commitment to medical research
threatens our ability to support a medical research enterprise that is
capable of taking full advantage of existing and emerging scientific
opportunities.
Perhaps one of the greatest concerns is the obstacle these
continued cuts will present to the next generation of scientists, who
will see training funds slashed and the possibility of sustaining a
career in research diminished. NIH plays a significant role in
supporting the next generation of innovators, the young and talented
scientists and physicians who will be responsible for the breakthroughs
of tomorrow.
The challenges of maintaining a cadre of physician-scientists to
facilitate translation of basic research to human medicine, ensuring a
biomedical workforce that reflects the racial and gender diversity of
our citizenry, and maximizing our Nation's human capital to solve our
most pressing health problems will only be addressed through continued
support of NIH.
NIH is Critical to U.S. Competitiveness
Our country still has the most robust medical research capacity in
the world, but that capacity simply cannot weather repeated blows such
as persistent below-inflation funding levels and cuts of sequestration,
which jeopardize our competitive edge in an increasingly innovation-
based global marketplace.
Other countries have recognized the critical role that biomedical
science plays in innovation and economic growth and have significantly
increased their investment in biomedical science. Between 1999 and
2009, Asia's share (including China, India, Japan, Malaysia, Singapore,
South Korea, Taiwan, and Thailand) of worldwide research and
development (R&D) expenditures grew from 24 percent to 32 percent,
while U.S. R&D expenditures declined from 38 percent to 31 percent.
While the U.S. currently leads the world in R&D spending, China's
increasing investment in R&D is projected to close the gap and surpass
the U.S. in total R&D spending by about 2022. The European Commission
also has recently urged its member Nations to increase their investment
in research substantially, recommending budgets of 80 billion Euro
(equivalent to $108 billion) from 2014 to 2020, a 40 percent increase
over the previous 7-year period.
This shift in funding raises the concern that talented medical
researchers from all over the world, who once flocked to the U.S. for
training and stayed to contribute to our innovation-driven economy, are
now returning to better opportunities in their home countries. We
cannot afford to lose that intellectual capacity, much less the jobs
and industries fueled by medical research. The U.S. has been the global
leader in medical research because of Congress's bipartisan recognition
of NIH's critical role. To maintain our dominance, we must reaffirm
this commitment to provide NIH the funds needed to maintain our
competitive edge.
NIH: An Answer to Challenging Times
The Ad Hoc Group's members recognize the tremendous challenges
facing our Nation's economy and acknowledge the difficult decisions
that must be made to restore our country's fiscal health. Nevertheless,
we believe strongly that NIH is an essential part of the solution to
the Nation's economic restoration. Strengthening our commitment to
medical research, through robust funding of the NIH, is a critical
element in ensuring the health and well-being of the American people
and our economy.
Therefore, the Ad Hoc Group for Medical Research recommends that
NIH receive at least $32 billion in fiscal year 2015 as the next step
toward a multi-year increase in our Nation's investment in medical
research.
______
Prepared Statement of the AIDS Alliance for Women, Infants, Children,
Youth & Families
Dear Chairman Harkin Ranking Moran, and Members of the
Subcommittee: AIDS Alliance for Women, Infants, Children, Youth &
Families was founded in 1994 to help respond to the unique concerns of
HIV-positive and at-risk women, infants, children, youth, and families.
AIDS Alliance conducts policy research, education, and advocacy on a
broad range of HIV/AIDS prevention, care, and research issues. We are
pleased to offer written testimony for the record in opposition of the
fiscal year 2015 budget proposal consolidating Ryan White Part D
funding into Part C and in support of maintaining Part D of the Ryan
White Program as part of the fiscal year 2015 Labor, Health and Human
Services, Education, and Related Agencies appropriations measure. This
testimony also has the support of the Elizabeth Glaser Pediatric AIDS
Foundation.
Ryan White Part D Funding Request
Sufficient funding of the Ryan White Program is necessary to
provide quality care for individuals living with HIV/AIDS. We thank the
Subcommittee for its continuous support of Ryan White Part D Programs,
providing $75 million to the program in fiscal year 2014. While the
AIDS Alliance for Women, Infants, Children, Youth & Families
understands that these are difficult economic times, we are requesting
the Subcommittee to maintain its commitment to the Ryan White Part D
program and restore its funding eliminated in the President's fiscal
year 2015 budget proposal and increase Ryan White Part D funding by
$9.9 million in fiscal year 2015.
Ryan White Part D Background and History
Over concerns with the increase in the number of pediatric AIDS
cases, Congress first acted to address pediatric cases in 1987 by
providing $5 million for the Pediatric AIDS Demonstration Projects in
the fiscal year 1988 budget. Those demonstration projects became part
of the Ryan White CARE Act of 1990 which today is known as Ryan White
Part D and have served thousands of women, infants, children, youth and
families. Since the program's inception in 1988, Part D programs have
been and continue to be the entry point into medical care for women and
youth and, in many communities or regions, Part D programs are the only
perinatal clinical service available to serve HIV-positive pregnant
women and youth when payments for such services are unavailable from
other sources. Ryan White Part D programs have been extremely effective
in bringing the most vulnerable populations into and retained in care
and is the lifeline for women, infants, children and youth living with
HIV/AIDS. The Part D programs are instrumental in preventing mother-to-
child transmission of HIV and for ensuring that women, including HIV-
positive pregnant women, HIV exposed infants, children and youth have
access to quality HIV care. The program is built on a foundation of
combining medical care and essential support services that are
coordinated, comprehensive, and culturally and linguistically
competent. This model of care addresses the healthcare needs of the
most vulnerable populations living with HIV/AIDS in order to achieve
optimal health outcomes.
In 2012, Part D provided funding to 114 community-based
organizations, academic medical centers and hospitals, federally
qualified health centers, and health departments in 39 States and
Puerto Rico. These federally, directly-funded grantees provide HIV
primary care, specialty and subspecialty care, oral health services,
treatment adherence monitoring and education services pertaining to
opportunities to participate in HIV/AIDS-related clinical research.
These grantees also provide support services which include case
management (medical, non-medical, and family-centered); referrals for
inpatient hospital services; treatment for substance use, and mental
health services. Part D grantees also receive assistance from other
parts of the Ryan White Program that help support HIV testing and
linkage to care services; provide access to medication; additional
medical care, such as dental services; and key support services, such
as case management and transportation, which all are essential
components of the highly effective Ryan White HIV care model. This
model has continuously provided comprehensive quality healthcare
delivery systems that have been responsive to women, infants, children,
youth and families for two decades.
A Response to Women, Infants, Children, and Youth
The Ryan White Program has been enormously successful in meeting
its mission to provide life-extending care and services. Yet, even
though we have made significant progress in decreasing HIV-related
morbidity and mortality, much work remains to be done. While accounting
for less that 6 percent of Ryan White direct care dollars (minus ADAP
and Part F), Ryan White Part D programs have been extremely effective
in bringing our most vulnerable populations into care and developing
medical care and support services especially designed to reach women,
children, youth, and families. Part D funded programs played a leading
role in reducing mother-to-child transmission of HIV-from as many as
2,000 babies born HIV positive in 1990 to roughly 200 cases in 2010
through aggressive efforts to reach out to pregnant women. Appropriate
funding is critical to maintain and improve upon this success, as there
are still approximately 8,000 HIV-positive women giving birth every
year in the United States that need counseling, services and support to
prevent pediatric HIV Infections. According to the CDC, youth account
for 39 percent of all new HIV infections in the U.S. As of 2010, one in
four new HIV infections occur among young people ages 13-24. Most new
HIV infections in youth (about 70 percent) occur in gay and bisexual
males, most of whom are African Americans. Of the new HIV infections
among youth, 2,100 are among young women; two-thirds of these are among
young African American women. Ryan White Part D programs are the entry
point into medical care for many HIV positive youth and leads the
Nation's effort in recruiting and retaining HIV positive youth to
comprehensive medical care and support services. According to the
Health Resources and Services Administration, more than 37 percent of
women receiving medical care in Ryan White Programs do so through Part
D. Additionally, Part D provides medical and supportive services to a
large number of women over 50 who are heading into their senior years
as HIV survivors which is a testament to the high standard of care
provided to Ryan White Part D programs. Support and care through the
Ryan White Part D program was and continues to be funding of last
resort for the most vulnerable women and children, who often have
fallen through the cracks of other public health safety nets. Full
implementation of the Affordable Care Act with continuation of the Ryan
White Program will dramatically improve health access and outcomes for
many more women, infants, children, and youth living with HIV disease.
Proposed Consolidation
The medical and supportive services provided by Ryan White Part D
are unique and are not currently being provided by other parts of the
Ryan White Program, including Ryan White Part C. These services are
uniquely tailored to address the needs of women, including HIV positive
pregnant women, HIV exposed infants, children and youth living with
HIV/AIDS. The proposed consolidation of Part D funding into Part C in
the Federal budget would eliminate a strong safety net for our most
vulnerable populations and weaken the systems of care Part D programs
have created and invested in for more than 25 years. Furthermore, the
loss of Part D funds in some community areas would profoundly impact
access to comprehensive HIV care and treatment for women, infants,
children and youth. Many of the population served by Part D will be
lost or never enter into care. We will not make progress in ending HIV/
AIDS in this country without supporting all of the Parts of Ryan White.
Conclusion
These are difficult economic times, and we recognize the
considerable fiscal constraints Congress faces in allocating limited
Federal dollars as well as the need to reduce administrative burdens
associated with the overall operational aspects of Ryan White programs.
However, it is unclear how the proposed consolidation of Part D funding
into Part C of the program will be implemented to ensure the
continuation of the delivery of life-saving HIV/AIDS care and treatment
to the most vulnerable populations without destabilizing existing
models of care created to address the unique needs of these
populations. Without the Ryan White Part D program, many of these
medically-underserved women, infants, children and youth would not
receive the vital primary care and support services traditionally
provided to them.
The AIDS Alliance for Women, Infants, Children, Youth & Families
respectfully requests that the Subcommittee consider this written
testimony for the record as you develop your fiscal year 2015
appropriations bill. Thank you.
[This statement was submitted by Dr. Ivy Turnbull, Deputy Executive
Director, AIDS Alliance for Women, Infants, Children, Youth &
Families.]
______
Prepared Statement of The AIDS Institute
Dear Chairman Harkin and Members of the Subcommittee: The AIDS
Institute, a national public policy, research, advocacy, and education
organization, is pleased to offer comments in support of critical HIV/
AIDS and hepatitis programs as part of the fiscal year 2015 Labor,
Health and Human Services, Education, and Related Agencies
appropriation measure. We thank you for supporting these programs over
the years, and hope you will do your best to adequately fund them in
the future in order to provide for and protect the health of many
Americans.
HIV/AIDS remains one of the world's worst health pandemics.
According to the CDC, in the U.S. over 636,000 people have died of AIDS
and there are 50,000 new infections each year. A record 1.1 million
people in the U.S. are living with HIV. Persons of minority races and
ethnicities are disproportionately affected. African Americans, who
make up just 12 percent of the population, account for 44 percent of
new infections. HIV/AIDS disproportionately affects low income people;
nearly 90 percent of Ryan White Program clients have a household income
of less than 200 percent of the Federal Poverty Level.
The U.S. government has played a leading role in fighting HIV/AIDS,
both here and abroad. The vast majority of the discretionary programs
supporting domestic HIV/AIDS efforts are funded through this
Subcommittee. We are keenly aware of current budget constraints and
competing interests for limited dollars, but programs that prevent and
treat HIV are inherently in the Federal interest as they protect the
public health against a highly infectious virus. If not adequately
funded, there will certainly be increased infections, more deaths, and
higher health costs.
With the advent of antiretroviral medicines, HIV has turned from a
near certain death sentence to a treatable chronic disease if people
have access to consistent and affordable healthcare and medications.
Through prevention, care and treatment, and research we now have the
ability to actually end AIDS. In 2011, a ground-breaking clinical trial
(HPTN 052)--named the scientific breakthrough of the year by Science
magazine--found that HIV treatment not only saves the lives of people
with HIV, but also reduces HIV transmission by more than 96 percent--
proving that HIV treatment is also HIV prevention. In order to realize
these benefits, people with HIV must be diagnosed through testing, and
linked to and retained in care and treatment.
We also have a National HIV/AIDS Strategy that sets clear goals and
priorities, and brings the Federal agencies addressing HIV together to
ensure resources are well coordinated. Over the past 30 years we have
made great progress in the fight against HIV/AIDS and are truly at a
tipping point. However, without stable and adequate funding that
progress is in jeopardy, as well as the lives of millions who are or
will be infected.
The Ryan White Program
The Ryan White HIV/AIDS Program provides some level of medical
care, drug treatment, and support services to approximately 554,000
low-income, uninsured, and underinsured individuals with HIV/AIDS. With
people living longer and continued new diagnoses, the demands on the
program continue to grow and many needs remain unmet. According to the
CDC, only 37 percent of people living with HIV in the U.S. are retained
in HIV care, only 33 percent have been prescribed antiretroviral
treatment, and only 25 percent are virally suppressed. We have a long
way to go before we can realize the dream of an AIDS-free generation.
With continued funding we can improve these numbers and health
outcomes.
The AIDS Drug Assistance Program (ADAP), one component of the Ryan
White Program, provides States with funds to pay for medications for
over 200,000 people. Over the last couple of years, as more infections
were identified due to increased HIV testing and people lost their jobs
and health insurance, demand on the program far outpaced its budget.
This led to ADAP wait lists of 9,300 people. We are thankful that
President Obama and Congress allocated additional funds, which when
combined with assistance from pharmaceutical companies has virtually
eliminated the wait list. With inadequate funding that could all
change.
We urge you to ensure that ADAP and the rest of the Ryan White
Program receive adequate funding to keep up with the growing demand.
According to NASTAD, enrollment in ADAP increased by 8 percent between
fiscal year 2012 and fiscal year 2013, and utilization reached its
highest level ever. With this increased demand for medications comes a
corresponding increase in medical care and support services provided by
all other parts of the program.
As the Affordable Care Act (ACA) is implemented, there will be
expanded opportunities for healthcare coverage for some Ryan White
clients. While it will result in some cost shifting for medications and
primary care, it will never be a substitute for the Ryan White Program.
Over 70 percent of Ryan White Program clients today have some sort of
insurance coverage, mostly through traditional Medicaid and Medicare.
Their coverage will not change with health reform; the Ryan White
Program will be needed as it is today. The Medicaid expansion is a
State option and not all States are moving forward with it at this
time. As ACA is implemented, benefits will differ from State to State
and there will be many gaps that will have to be filled by the Ryan
White Program. Plans will not offer all of the comprehensive essential
support services that the Program does, such as case management,
transportation, and nutritional services, that are needed to ensure
retention in medical care and adherence to drug treatment. This
approach of coordinated, comprehensive, and culturally competent care
leads to better health outcomes. Therefore, the Ryan White Program,
while it may need to change in the future, must continue and must be
adequately funded.
The AIDS Institute urges the Committee to reject the President's
budget proposal to eliminate dedicated funding for Part D of the Ryan
White Program and transfer it to Part C. Part D serves women, infants,
children, and youth with HIV/AIDS and is a well-established system of
care that has worked since 1988 in nearly eliminating perinatal
infection and providing medical care and family-centered support that
helps ensure these vulnerable populations remain in care and adherent
to their medications. With youth, particularly black gay youth, being
the only population experiencing an increase in HIV incidence, we
cannot afford to dramatically alter the only Ryan White Program part
dedicated to their care. While changes to the structure of the Ryan
White Program might be needed in the future, it should not be done
through the appropriations process and not without community input.
CDC HIV Prevention
As a Nation, we must do more to prevent new infections, but we only
allocate 3 percent of our HIV/AIDS spending towards prevention. All the
care and treatments costs would be saved if we did not have the
infections in the first place. Preventing just one infection would save
$402,000 in future lifetime medical costs. Preventing all the new
50,000 cases in just 1 year would translate into an astounding $20
billion saved in lifetime medical costs.
With more people living with HIV than ever before, there are
greater chances of HIV transmission. The CDC and its grantees have been
doing their best with limited resources to keep the number of
infections stable, but that is not good enough. It is focusing
resources on those populations and communities most impacted by HIV and
investing in those programs that will prevent the most number of
infections. This includes young black gay men, who experienced a 38
percent increase in new infections from 2008-2010 and is a population
which merits additional attention and resources
With over 200,000 people living with HIV who are unaware of their
infection, the CDC is also focused on increased testing programs.
Testing people early and linking them to care and treatment is critical
not only for their own health outcomes but also in preventing new
infections.
The CDC estimates that in 2010, 26 percent of all new HIV
infections occurred among youth ages 13 to 24. Nearly 75 percent of
those infections were among young gay men. Clearly, we must do a better
job of educating the youth of our Nation, including gay youth, about
HIV. Adequately funding the HIV Division of Adolescent and School
Health (DASH) will help address this critical need.
CDC Viral Hepatitis Prevention
Given that more than 5.3 million people in the U.S. are living with
hepatitis B and/or C and 65-75 percent of them are undiagnosed, funding
for the Hepatitis Prevention Division must be increased. With a 25
percent mortality rate among affected baby boomers--those born between
1945 and 1965--and with prevalence rates two times higher than whites
for African Americans in that birth cohort, we cannot afford to
inadequately fund this program. The current amount of only $29 million
is far too small to conduct testing, surveillance, and other hepatitis
prevention and educational programs for the entire country. Currently
there is no national surveillance system to track hepatitis infections
and testing programs are inadequate; therefore the majority of the
millions affected will never become aware of their disease until they
present with liver cancer or cirrhosis. Increased funding for testing
and surveillance could bring more people into care and treatment
allowing them the chance to receive new and more effective treatments
that actually can result in curing their hepatitis.
HIV/AIDS Research at the National Institutes of Health (NIH)
While we have made great strides in the area of HIV/AIDS, there is
still a long way to go. Continued research at the NIH is necessary to
learn more about the disease and to develop new treatments and
prevention tools. Recent breakthroughs have provided functional cures
in a few instances in infants and adults. Work also continues on
vaccine research as scientists learn more about the disease, and
combined with cure research it may be possible to see the end of AIDS
if funding is maintained.
Again, we thank you for your continued support of these programs
critical to so many individuals and communities nationwide. We have
made great progress, but we are still far from achieving our goal of an
AIDS-free generation. We now have the tools, but we need continued
leadership and the necessary resources to realize our goal. Thank you.
[This statement was submitted by Carl E Schmid II, Deputy Executive
Director, The AIDS Institute.]
______
Prepared Statement of The AIDS United
I am Ronald Johnson, Vice President of Policy and Advocacy at AIDS
United writing in reference to HIV funding at the Department of Health
and Human Services, on behalf of the 32 organizational members of our
Public Policy Committee and our over 90 programmatic directly funded
organizational grantees all of whom are many of the leading AIDS
Service Organizations across the Nation. AIDS United is a national
organization that seeks to end the AIDS epidemic in the United States
by combining private-sector fundraising, philanthropy, coalition
building, public policy expertise, and advocacy--as well as a network
of passionate local and State partners--to respond effectively and
efficiently to the HIV/AIDS epidemic in the communities most impacted
by the epidemic. Through its unique Public/Private Partnerships, Public
Policy Committee and targeted special grant-making initiatives, AIDS
United and its partners reach over 300 grassroots organizations. These
organizations provide HIV prevention, care, treatment, and support
services to underserved individuals and populations most impacted by
the HIV/AIDS epidemic including communities of color, women and gay and
bisexual men and men who have sex with men (MSM) as well as education
and training to providers of treatment services. It is our request that
you increase funding for the Department of Health and Human Services by
$7.361 billion in fiscal year 2015. This request includes an increase
of $931 million over fiscal year 2014 throughout the detailed request
listed below.
AIDS United understands the fiscal environment that the country is
wrestling with right now is austere. However, we know that investment
in prevention and retention in HIV care are critical in lowering the
number of new infections in the domestic HIV epidemic. As competing
budget priorities are weighed please keep in mind that HIV is 100
percent preventable, if we as a Nation muster the political will and
funding to address domestic HIV on level that meets the needs of the
epidemic. The increased funding for the domestic HIV/AIDS portfolio in
fiscal year 2015 will help reach the National HIV/AIDS Strategy (NHAS).
We look forward to working with you and your Administration in the
coming year on the fiscal year 2015 budget.
The Ryan White Program
Early and reliable access to HIV care and treatment is cost
effective and helps patients with HIV live healthy and productive
lives. The needs of the Ryan White Program (RWP) continue to grow, even
with the beginning of the implementation of the Affordable Care Act
(ACA) and the integration of the RWP there may still be many needs
unmet. In order to improve the continuum of care and progress toward an
AIDS-free generation, continued, robust funding for all parts of the
Ryan White Program in fiscal year 2015 will be necessary. The Ryan
White Program works in conjunction with Medicaid, Medicare and now the
Affordable Care Act, and as a result we believe more people living with
HIV will be able to receive and remain in care and on treatment.
It will take some time for enrollment to occur and assess the
impact of the ACA on the Ryan White Program. In the meantime, we urge
you to fund the Ryan White Program at a total of $2.44 billion in
fiscal year 2015, an increase of $123 million over fiscal year 2014,
distributed in the following manner: Part A: $687 million, Part B
(Care): $428 million, Part B (ADAP): $943 million, Part C: $225
million, Part D: $85 million, Part F/AETC: $35 million, Part F/Dental
$15 million.
AIDS United disagrees with the President's budget request and does
not support the consolidation of Part D with Part C. We believe it
should only be considered as part of a larger authorization process
after key data questions about the value of consolidation are answered.
HIV Prevention
CDC HIV Prevention and Surveillance
There still are 50,000 new infections annually and about 1 in 6
people living with HIV do not know they have the virus. Gay, bisexual,
and other men who have sex with men (MSM) account for 66 percent of all
new HIV infections. Between 2008 and 2010, infections among MSM
increased by 12 percent, and among MSM aged 13-24 years by 22 percent.
Black and Latino MSM, and especially those who are young continue to be
disproportionately affected. While we are making progress in decreasing
new infections among women, black women accounted for 64 percent of
women infected in 2010. Black and Hispanic women ages 13-24 accounted
for 82 percent of young women living with HIV in 2010 even though
together they represent only about 30 percent of women these ages.
Investing in HIV prevention today translates into less spending in
the future on care and treatment. Most CDC funding is distributed to
the primary implementers of prevention activities--State and local
public health departments and community based organizations. Increased
investments are critical to expand comprehensive prevention programs
and to successfully reach individuals at highest risk for infection.
Early detection of HIV, linkage and retention in care, and adherence to
treatment will suppress individual and community viral loads. Adequate
resources are necessary to carry out increased HIV testing programs,
targeted interventions, public education campaigns, and surveillance
activities needed to track new infections andCD4 and viral load
reporting.
For fiscal year 2015, we request an increase of $55 million over
fiscal year 2014 for a total of $812.7 million for the CDC Division of
HIV prevention and surveillance activities.
Division of Adolescent and School Health (DASH)
One-third of all new HIV infections are among young people under
the age of 29, the largest share of any age group. DASH is the only
federally funded adolescent health program in our Nation's schools,
helping education agencies provide school districts and individual
schools with the tools to implement high-quality, effective, and
sustainable programs to reduce HIV and other STD infections in
adolescents. Increased funding would help expand this vital
infrastructure beyond the currently funded 36 State or local education
agencies.
We request that the CDC Division of Adolescent and School Health
receive a total of $50 million, an increase of $21 million over fiscal
year 2014 final funding. This request includes $3 million in evaluation
transfer funds.
CDC STD Prevention
Given the strong link between HIV and other STDs, including high
rates of co-infection among certain populations, an increased
investment in STD programs is an essential component of HIV prevention.
Investments in STD prevention and treatment further the National HIV/
AIDS Strategy's goal of reducing new infections.
We request an increase of $54 million for a total of $211 million
for the CDC's Division of STD Prevention in fiscal year 2015.
CDC Viral Hepatitis Prevention
CDC estimates that up to 5.3 million people are living with
hepatitis B (HBV) and/or hepatitis C (HCV) in the U.S., and as many as
75 percent are not aware of their infection. In 2010 alone, 35,000
Americans were newly infected with HBV and 17,000 with HCV. It is
estimated that 10 percent of people living with HIV are co-infected
with hepatitis B and 25 percent are co-infected with hepatitis C.
We request an increase of $31 million above the fiscal year 2014
level, for a total of $60 million for the CDC's Division of Viral
Hepatitis.
Access to Sterile Syringes
About 1 of 12 new infections (8.6 percent) of HIV in 2011 was
related to injection drug use, a 28 percent decrease from 2008. One
factor leading to this reduction has been syringe exchange programs.
Numerous studies have shown syringe exchange programs can be an
evidence-based and cost-effective means to lower HIV and hepatitis
infections, reduce the use of illegal drugs and help connect people to
medical treatment, including substance abuse treatment. In a May 2012
letter, the President's Advisory Council on HIV/AIDS also supported
ending the Federal ban on syringe exchange and noted that doing so is
supported by public health, HIV/AIDS, viral hepatitis and harm
reduction communities as well.
We urge you to add language to end the ban on the use of Federal
funds for syringe exchange programs and to maintain language that
allows the use of local funds for syringe exchange programs in the
District of Columbia.
Abstinence-only
We also request that you eliminate the funding for failed
abstinence-only-until-marriage programs.
HIV/AIDS Research at the National Institutes of Health (NIH)
Research continues until better, more effective and affordable
prevention and treatment regimens--and eventually a cure--are developed
and universally available. For the U.S. to maintain its position as the
global leader in HIV/AIDS research for the 33 million people globally
of whom 1.1 million are Americans living with HIV, we must invest
adequate resources in the NIH. NIH AIDS research has produced startling
advances, including the HPTN 052 study of the prevention effects of
treatment that was named Breakthrough of the Year by Science magazine,
improved treatment programming and the first partially effective HIV
vaccine, continued AIDS research funding is essential.
In line with the Trans-NIH AIDS Research By-Pass Budget Estimate
for fiscal year 2013, please include $3.6 billion for HIV research at
the NIH, an increase of $610 million over fiscal year 2014.
Minority HIV/AIDS Initiative
HIV/AIDS continues to impact communities of color at an alarming
rate. According to the CDC, African Americans, more than any other
racial/ethnic group, continue to bear the greatest burden of HIV in the
U.S. While blacks represent approximately 12 percent of the total
population, they accounted for 44 percent of all new HIV infections in
2010. Hispanics represent approximately 16 percent of the total
population, but accounted for 21 percent of all new HIV infections. In
the Asian Pacific Islander, and Native American communities the numbers
of HIV infection are just as startling.
We request that the MAI be funded at $610 million in fiscal year
2015. We note that most of these funds are contained within the budgets
of the programs described above.
______
Prepared Statement of the Alzheimer's Association
The Alzheimer's Association appreciates the opportunity to comment
on the fiscal year 2015 appropriations for Alzheimer's disease
research, education, outreach and support at the U.S. Department of
Health and Human Services.
Founded in 1980, the Alzheimer's Association is the world's leading
voluntary health organization in Alzheimer's care, support and
research. Our mission is to eliminate Alzheimer's disease and other
dementias through the advancement of research; to provide and enhance
care and support for all affected; and to reduce the risk of dementia
through the promotion of brain health. As the world's largest nonprofit
funder of Alzheimer's research, the Association is committed to
accelerating progress of new treatments, preventions and, ultimately, a
cure. Through our funded projects and partnerships, we have been part
of every major research advancement over the past 30 years. Likewise,
the Association works to enhance care and provide support for all those
affected by Alzheimer's and reaches millions of people affected by
Alzheimer's and their caregivers.
Alzheimer's Impact on the American People and the Economy
In addition to the human suffering caused by the disease,
Alzheimer's is creating an enormous strain on the healthcare system,
families and the Federal budget. Alzheimer's is a progressive brain
disorder that damages and eventually destroys brain cells, leading to a
loss of memory, thinking and other brain functions. Ultimately,
Alzheimer's is fatal. Currently, Alzheimer's is the sixth leading cause
of death in the United States and the only one of the top ten without a
means to prevent, cure or slow its progression. Over five million
Americans are living with Alzheimer's, with 200,000 under the age of
65.
A Federal commitment can lower costs and improve health outcomes
for people living with Alzheimer's today and in the future. By making
Alzheimer's a national priority, we can create the same successes that
we have been able to achieve in other diseases that have been
prioritized by the Federal Government. Leadership from the Federal
Government has helped to lower the number of deaths from other major
diseases like heart disease, HIV/AIDS, many cancers, heart disease and
stroke. While those deaths have declined, deaths from Alzheimer's have
increased 68 percent between 2000 and 2010.
Alzheimer's is the most expensive disease in America. In fact, an
NIH-funded study in the New England Journal of Medicine confirmed that
Alzheimer's is the most costly disease in America, with costs set to
skyrocket at unprecedented rates. If nothing is done, as many as 16
million Americans will have Alzheimer's disease by 2050 and costs will
exceed $1.2 trillion (not adjusted for inflation), creating an enormous
strain on the healthcare system, families and the Federal budget. The
expense involved in caring for those with Alzheimer's is not just a
long-term problem. As the current generation of baby boomers age, near-
term costs for caring for those with Alzheimer's will balloon, as
Medicare and Medicaid will cover more than two-thirds of the costs for
their care.
Due to these projected increases, the graying of America threatens
the bankrupting of America. Caring for people with Alzheimer's will
cost all payers--Medicare, Medicaid, individuals, private insurance and
HMOs--$20 trillion over the next 40 years, enough to pay off the
national debt and still send a $10,000 check to every man, woman and
child in America. In 2014, America will spend an estimated $214 billion
in direct costs for those with Alzheimer's, including $150 billion in
costs to Medicare and Medicaid. Average per person Medicare costs for
those with Alzheimer's and other dementias are three times higher than
those without these conditions. Average per senior Medicaid spending is
19 times higher.
A primary reason for these costs is that Alzheimer's makes treating
other diseases more expensive, as most individuals with Alzheimer's
have one or more co-morbidity that complicate the management of the
condition(s) and increase costs. For example, a senior with diabetes
and Alzheimer's costs Medicare 81 percent more than a senior who only
has diabetes. Nearly 30 percent of people with Alzheimer's or another
dementia who have Medicare also have Medicaid coverage, compared with
11 percent of individuals without Alzheimer's or dementia. Alzheimer's
disease is also extremely prevalent in nursing homes, where 64 percent
of Medicare residents live with the disease.
With Alzheimer's, it is not just those with the disease who
suffer--it is also their caregivers and families. In 2013, 15.5 million
family members and friends provided unpaid care valued at over $220
billion. Caring for a person with Alzheimer's takes longer, lasts
longer, is more personal and intrusive, and takes a heavy toll on the
health of the caregivers themselves. More than 60 percent of
Alzheimer's and dementia caregivers rate the emotional stress of
caregiving as high or very high, with one-third reporting symptoms of
depression. Caregiving may also have a negative impact on health,
employment, income and family finances. Due to the physical and
emotional toll of caregiving on their own health, Alzheimer's and
dementia caregivers had $9.3 billion in additional health costs in
2013.
Changing the Trajectory of Alzheimer's
Until recently, there was no Federal Government strategy to address
this looming crisis. In 2010, thanks to bipartisan support in Congress,
the National Alzheimer's Project Act (NAPA) (Public Law 111-375) passed
unanimously, requiring the creation of an annually-updated strategic
National Alzheimer's Plan (Plan) to help those with the disease and
their families today and to change the trajectory of the disease for
the future. The Plan is required to include an evaluation of all
federally-funded efforts in Alzheimer's research, care and services--
along with their outcomes. In addition, the Plan must outline priority
actions to reduce the financial impact of Alzheimer's on Federal
programs and on families; improve health outcomes for all Americans
living with Alzheimer's; and improve the prevention, diagnosis,
treatment, care, institutional-, home-, and community-based Alzheimer's
programs for individuals with Alzheimer's and their caregivers. NAPA
will allow Congress to assess whether the Nation is meeting the
challenges of this disease for families, communities and the economy.
Through its annual review process, NAPA has enabled, for the first
time, Congress and the American people to answer this simple question:
Did we make satisfactory progress this past year in the fight against
Alzheimer's?
As mandated by NAPA, the Secretary of Health and Human Services, in
collaboration with the Advisory Council on Alzheimer's Research, Care
and Services, has developed the first-ever National Plan to Address
Alzheimer's Disease in May of 2012 and subsequently released the 2014
Update to the National Plan to Address Alzheimer's Disease this past
April. The Advisory Council, composed of both Federal members and
expert non-Federal members, is an integral part of the planning process
as it advises the Secretary in developing and evaluating the annual
Plan, makes recommendations to the Secretary and Congress, and assists
in coordinating the work of Federal agencies involved in Alzheimer's
research, care, and services.
Having a plan with measurable outcomes is important. But unless
there are resources to implement the plan and the will to abide by it,
we cannot hope to make adequate progress. If we are going to succeed in
the fight against Alzheimer's, Congress must provide the resources the
scientists need. Understanding this and following the recommendation of
scientists at NIH, Congress passed the Consolidated Appropriations Act
of 2014 (Public Law 113-76) which included a $100 million increase for
Alzheimer's research. These funds are a critically needed down payment
for needed research and services for Alzheimer's patients and their
families.
A disease-modifying or preventive therapy would not only save
millions of lives but would save billions of dollars in healthcare
costs. Specifically, if a treatment became available in 2015 that
delayed onset of Alzheimer's for 5 years (a treatment similar to anti-
cholesterol drugs), savings would be seen almost immediately, with
Medicare and Medicaid spending reduced by $42 billion in 2020.
Today, despite the Federal investment in Alzheimer's research, we
are only just beginning to understand what causes the disease.
Americans are growing increasingly concerned that we still lack
effective treatments that will slow, stop, or cure the disease, and
that the pace of progress in developing breakthrough discoveries is
much too slow to significantly impact on this growing crisis. For every
$26,500 Medicare and Medicaid spends caring for individuals with
Alzheimer's, the National Institutes of Health (NIH) spends only $100
on Alzheimer's research. Scientists fundamentally believe that we have
the ideas, the technology and the will to develop new Alzheimer's
interventions, but that progress depends on a prioritized scientific
agenda and on the resources necessary to carry out the scientific
strategy for both discovery and translation for therapeutic
development.
For too many individuals with Alzheimer's and their families, the
system has failed them, and today we are unnecessarily losing the
battle against this devastating disease. Despite the fact that an early
and documented formal diagnosis allows individuals to participate in
their own care planning, manage other chronic conditions, participate
in clinical trials, and ultimately alleviate the burden on themselves
and their loved ones, as many as half of the more than five million
Americans with Alzheimer's have never received a formal diagnosis.
Unless we create an effective, dementia-capable system that finds new
solutions to providing high quality care, provides community support
services and programs, and addresses Alzheimer's health disparities,
Alzheimer's will overwhelm the healthcare system in the coming years.
For example, people with Alzheimer's and other dementias have more than
three times as many hospital stays as other older people. Furthermore,
one out of seven individuals with Alzheimer's or another dementia lives
alone and up to half do not have an identifiable caregiver. These
individuals are more likely to need emergency medical services because
of self-neglect or injury, and are found to be placed into nursing
homes earlier, on average, than others with dementia. Ultimately,
supporting individuals with Alzheimer's disease and their families and
caregivers requires giving them the tools they need to plan for the
future and ensuring the best quality of life for individuals and
families impacted by the disease. It is vital that we make the
investments in Alzheimer's that will fulfill the goals of the National
Alzheimer's Plan. The Alzheimer's Association urges Congress to support
an additional $200 million for research activities and priorities
included in the National Alzheimer's Plan required under Public Law
111-375.
Additional Alzheimer's programs
National Alzheimer's Call Center: The National Alzheimer's Call
Center, funded by the AoA, provides 24/7, year-round telephone support,
crisis counseling, care consultation, and information and referral
services in 140 languages for persons with Alzheimer's, their family
members and informal caregivers. Trained professional staff and
master's-level mental health professionals are available at all times.
In the 12 month period ending July 31, 2013, the Call Center handled
over 300,000 calls through its national and local partners, and its
online message board received over 40,000 visits a month. Additionally,
the Association provides a two-to-one match on the Federal dollars
received for the call center. The Alzheimer's Association urges
Congress to support $1.3 million for the National Alzheimer's Call
Center.
Healthy Brain Initiative (HBI): The Centers for Disease Control and
Prevention's (CDC) HBI program works to educate the public, the public
health community and health professionals about Alzheimer's as a public
health issue. Although there are currently no treatments to delay or
stop the deterioration of brain cells caused by Alzheimer's, evidence
suggests that preventing or controlling cardiovascular risk factors may
benefit brain health. In light of the dramatic aging of the population,
scientific advancements in risk behaviors, and the growing awareness of
the significant health, social and economic burdens associated with
cognitive decline, the Federal commitment to a public health response
to this challenge is imperative. The fiscal year 2014 omnibus funding
bill increased funding for HBI by $1.5 million in order to bolster
caregiver surveillance. The Alzheimer's Association urges Congress to
support $3.3 million for the Healthy Brain Initiative.
Alzheimer's Disease Supportive Services Program (ADSSP): The ADSSP
at the AoA supports family caregivers who provide countless hours of
unpaid care, thereby enabling their family members with Alzheimer's and
dementia to continue living in the community. The program develops
coordinated, responsive and innovative community-based support service
systems for individuals and families affected by Alzheimer's. The
Alzheimer's Association urges Congress to support $13.4 million for the
Alzheimer's Disease Supportive Services Program.
Conclusion
The Association appreciates the steadfast support of the
Subcommittee and its priority setting activities. We look forward to
continuing to work with Congress in order to address the Alzheimer's
crisis. We ask Congress to address Alzheimer's with the same bipartisan
collaboration demonstrated in the passage of the National Alzheimer's
Project Act (Public Law 111-375) and with a commitment equal to the
scale of the crisis.
______
Prepared Statement of the Alzheimer's Foundation of America
On behalf of the Alzheimer's Foundation of America (AFA), a
national nonprofit organization that unites more than 1,600 member
organizations nationwide with the goal of providing optimal care and
services to individuals confronting dementia, and to their caregivers
and families, we are making the following appropriations requests for
programs impacting Alzheimer's disease caregiving services and research
in the fiscal year 2015 budget. These Federal programs and support
services are vital to providing necessary care supports and promoting
best practice tools to family caregivers, and advancing promising
clinical research.
Specifically, AFA makes the following appropriations requests for
these specific agencies and programs:
National Institutes of Health (NIH):
Adequate investment in scientific research that could lead to new
treatments and cures is critical in order to reduce long-term
healthcare costs. We appreciated Congress' efforts in the fiscal year
2014 budget which provided an additional $80 million for clinical
research into Alzheimer's disease. AFA urges the Committee to build on
this modest increase and provide an additional $500 million for
Alzheimer's disease research and enhanced investments for caregiving
supports and services in fiscal year 2015. Additional resources will
fund effective pharmaceutical therapies to prevent, cure or slow the
progression of Alzheimer's disease, and provide the necessary seed
money to implement and facilitate the ambitious and laudable goals of
the ``National Plan to Address Alzheimer's Disease.''
AFA also urges the Committee to include $32 billion in total
funding for NIH, as recommended by the Ad Hoc Group for Medical
Research and a bi-partisan group of Members of Congress including Reps.
McKinley, Davis, Carson and King. Even if funding remains flat, NIH's
actual budget will still be effectively cut as spending will not be
able to keep pace with biomedical inflation.
--National Institute on Aging (NIA): Since NIA is the primary
agency responsible for Alzheimer's disease research, AFA urges the
Committee to include a minimum budget appropriation of $1.7 billion, an
increase of $500 million for NIA for fiscal year 2015.
NIA leads the national scientific effort to understand the nature
of aging in order to promote the health and well-being of older adults,
whose numbers are projected to rise dramatically in the coming years
due to increased life expectancy and the aging of the baby boom
generation.
This funding is essential to increase the NIA's baseline to a level
consistent with comparable research initiatives conducted under the
auspices of NIH, and to support additional research into Alzheimer's
disease and related dementias. This is particularly vital, as
Alzheimer's disease holds the infamous position of being the only one
of the top ten leading causes of death with a rising death rate.
Administration on Community Living (ACL) programs:
AFA would like to single out the following programs within the ACL
that are critical to individuals with Alzheimer's disease and their
caregivers:
--National Family Caregiver Support Program (NFCSP): NFCSP provides
grants to States and territories, based on their share of the
population aged 70 and over, to fund a range of supportive services
that assist family and informal caregivers in caring for their loved
ones at home for as long as possible, thus providing a more person-
friendly and cost-effective approach than institutional care. Last
year's appropriation of $146 million cannot possibly keep up with the
need for respite care as our population ages. AFA urges that $156
million be appropriated in fiscal year 2015 to support this important
program.
--Lifespan Respite Care Program (LRCP): AFA urges the Committee to
commit $10 million to LRCP in fiscal year 2015. LRCP provides
competitive grants to State agencies working with Aging and Disability
Resource Centers and non-profit State respite coalitions and
organizations to make quality respite care available and accessible to
family caregivers regardless of age or disability by establishing State
Lifespan Respite Systems.
--Alzheimer's Disease Demonstration Grants (ADDG): Existing
resources for the Alzheimer's population and their caregivers are
already tapped out, at a time when demand is continuing to rise in line
with the skyrocketing incidence of this disease. AFA supports funding
of $9 million for the ADDG program which fosters the development of
innovative models of care for persons with Alzheimer's disease and
their caregivers and is designed to improve responsiveness of the home
and community based care system to persons with dementia including
underserved minority, rural and low-income persons.
--Alzheimer's Disease Initiative (ADI): AFA supports the
President's fiscal year 2015 budget request of $12 million for this
program that for services such as support for caregivers in the
community, improving healthcare provider training, and raising public
awareness. Research shows that education, counseling and other support
for family caregivers can delay institutionalization of loved ones and
improve a caregiver's own physical and mental well-being--thus reducing
costs to families and government. In addition, AFA supports an
appropriation of $5 million for the Alzheimer's Disease Communications
Campaign.
Food and Drug Administration (FDA):
AFA supports FDA funding in fiscal year 2015 that fully restores
the agency's base lost in the fiscal year 2013 sequester and provides
for a modest additional funding above that level. Specifically, we are
requesting budget authority appropriations of $2.78 billion for FDA,
$223 million above fiscal year 2014 appropriated spending.
FDA activities are necessary to ensure proper evaluation and
testing of pharmaceutical treatments for Alzheimer's disease before
these drugs enter the market. In addition, with the science of this
disease becoming more complex, FDA plays an increasingly important and
often resource-intensive role in pharmaceutical innovation. AFA's
request is in line with the appropriations request being recommended by
the Alliance for a Stronger FDA and the Coalition to Accelerate Cure/
Treatments for Alzheimer's Disease (ACT-AD).
As we work toward meeting the goal of the historic ``National Plan
to Address Alzheimer's Disease'' to prevent and effectively treat
Alzheimer's disease by 2025, adequate resources must be committed to
meet the pending challenge. Taken together, these programs represent a
lifeline to families who care for a loved one with Alzheimer's disease
and provide hope to Americans living with the disease and those who
face it in the future that there will be funding for a cure.
AFA thanks the Committee for the opportunity to present its
recommendations and looks forward to working with you through the
appropriations process. Please contact me or Eric Sokol, AFA's vice
president of public policy, at esokol@alzfdn.org if you have any
questions or require further information.
[This statement was submitted by Hon. Charles J. Fuschillo, Jr.,
Chief Executive Officer, Alzheimer's Foundation of America.]
______
Prepared Statement of the America Achieves
Chairman Harkin and Ranking Member Moran: Results for America
(RFA), an initiative of America Achieves, is pleased to present our
recommendations for fiscal year 2015 to the Senate Appropriations
Subcommittee on the Departments of Labor, Health and Human Services,
and Education.
The attached letter and table outline the evidence-based policies
and programs RFA and our coalition partners are requesting from your
Subcommittee for fiscal year 2015 to help improve outcomes for young
people, their families, and communities.
Over the last several years, all levels of government have taken
critical steps to change the way taxpayer dollars are invested to
ensure limited resources are driven toward high-impact solutions that
get results. To significantly improve outcomes for young people, their
families, and communities in the context of constrained resources and
mounting demands, the Federal Government should identify and invest in
``what works,'' and be a catalyst for, and funder of, effective and
innovative solutions that produce greater social impact. While public
debate focuses on more or less resources, it is critical to identify
how to get better results from existing resources. This approach has a
strong history of bipartisan support. President George W. Bush's
Administration put a priority on improving the performance of Federal
programs and encouraged more rigorous evaluations to assess their
effectiveness. The Obama Administration has built on this effort by
supporting an increasing number of evidence and evaluation-based
policies and programs. Mayors and governors from both parties across
the country are also increasingly using data and evidence to steer
public dollars to more effectively address needs in their communities
and States.
I want to thank you for the positive steps you have taken over the
last several years toward building a strong evidence-based, results-
driven policy agenda and look forward to working with you in the months
and years ahead.
On March 13, 2014, the following 72 organizations sent a letter to
Chairwoman Mikulski, Chairman Rogers, and Ranking Members Shelby and
Lowey requesting bill and report language to invest Federal funds in
what works. The letter and a summary of our recommendations for fiscal
year 2015 for the House Appropriations Subcommittee on the Departments
of Labor, Health and Human Services, and Education follow:
invest in what works
Dear Chairwoman Mikulski, Chairman Rogers, Ranking Member Shelby,
and Ranking Member Lowey:
We are writing to urge you to include the attached ``Invest in What
Works'' provisions in the subcommittee appropriations bills and reports
for the Departments of Labor, Health and Human Services, Education, and
Related Agencies, and the Departments of Commerce, Justice, Science,
and Related Agencies for fiscal year 2015.
America is facing enormous social and economic shifts, budget
constraints at all levels of government, significant demographic
changes, and an increasingly globally competitive, changing workforce.
While the recently-enacted fiscal year 14 omnibus appropriations law
includes an unprecedented commitment to evidence and evaluation, we
must continue to focus on improving the ways in which Federal taxpayer
dollars are spent in fiscal year 15 and beyond in order to be able to
significantly improve outcomes for young people, their families, and
communities.
We thank you for the positive steps you have taken over the last
several years toward building a strong evidence-based, results-driven
policy agenda and encourage you to reaffirm your commitment to
improving outcomes for all Americans by incorporating the attached
``Invest in What Works'' recommendations in the fiscal year 2015
appropriations bills and committee reports.
Thank you for your consideration of our requests.
Sincerely,
AdvancEd
AIDS United
Alliance College-Ready Public Schools
Amos House (RI)
Aspire Public Schools
BELL
Breakthrough Schools
Brighton Center, Inc. (KY)
Capital Impact Partners
Center for Employment Opportunities
Center for Research and Reform in Education, Johns
Hopkins University
Champlain Housing Trust (VT)
Cincinnati Works
Citizen Schools
City First Homes and City First Enterprises (DC)
City Year, Inc.
CLUE (Comunidades Latinas Unidas En Servicio) (MN)
CommonBond Communities (MN)
Communities in Schools
Community Action Duluth
Community Training and Assistance Center (CTAC)
Congreso de Latinos Unidos Inc.
CSH
Edna Martin Christian Center (IN)
Education Northwest
Emerge Community Development (MN)
Family Resources Community Action (RI)
Focus: HOPE (MI)
Gestalt Community Schools
Greater Southwest Development Corporation (IL)
GreenLight Fund
Home Start, Inc. (CA)
Housing Leadership Council, Inc. (FL)
IDEA Public Schools
Jane Addams Resource Corporation (IL)
KIPP
Knowledge Alliance
LISC
Metropolitan Family Services (IL)
Mile High United Way
National Forum to Accelerate Middle-Grades Reform
National Fund for Workforce Solutions
New Profit Inc.
North County Lifeline (CA)
Operation ABLE (MI)
Project for Pride in Living, Inc. (MN)
Providence Housing Authority
Reading Partners
REDF
Results for America
Rocketship Education
Rubicon Programs
Safer Foundation (IL)
Santa Maria Community Services (OH)
SER-Jobs for Progress of the Texas Gulf Coast, Inc.
SER Metro Detroit, Jobs for Progress, Inc.
Southeast Community Services Inc. (IN)
Southwest Solutions (MI)
StriveTogether
Success for All Foundation
Teach For America
Teach Plus
The SEED Foundation
Turnaround For Children
United Way of Greater Cincinnati
United Way for Southeastern Michigan
Urban Alliance
U.S. Soccer Foundation
Venture Philanthropy Partners
Volunteers of America Texas Inc.
Year Up
Youth Villages
RECOMMENDATIONS FOR FISCAL YEAR 2015
.................
U.S. DEPARTMENT OF LABOR
Workforce Innovation Fund--with up to $10,000,000 for $60,000,000
Pay for Success initiatives.........................
Agency-Wide Evaluation Set-Aside--1 percent of .................
discretionary funds to be used by the Chief
Evaluation Office for program evaluations...........
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Head Start Designation Renewal System--set-aside $25,000,000
within the total provided for Head Start............
Mental Health Service Block Grant Program--at least 5 .................
percent set-aside for evidence-based programs to
address the needs of individuals with early serious
mental illness......................................
U.S. DEPARTMENT OF EDUCATION
First in the World--with $20,000,000 set-aside for $100,000,000
minority-serving institutions.......................
Investing in Innovation (i3)--language directing the $215,000,000
Department to provide continuation grants to certain
current i3 grantees that are demonstrating strong
interim outcomes but have not had sufficient time to
achieve their program goals.........................
Replication and Expansion of High Quality Charter $75,000,000
Schools--set-aside within the total provided for the
Charter School Program..............................
Title II-A--Effective Teachers and Leaders--language .................
requiring the Secretary to set aside 25 percent of
ESEA Title II-A funds for competitive grants to
States, high need local school districts, and
national non-profit organizations, including 10
percent set-aside for the Supporting Effective
Educator Development (SEED) program.................
Titles I and II--language directing States to set- .................
aside 1 percent of Title I and II funds, prior to
distribution to local school districts (LSD), and to
award these funds on a competitive basis to the 25
percent of LSD's with the highest poverty levels
through a tiered funding frame-work.................
IDEA Results-Driven Accountability Grants--set-aside $100,000,000
to implement promising evidence-based reforms.......
Agency-Wide Evaluation Set-aside--1 percent of .................
discretionary funds (not including Pell Grants) for
program evaluations.................................
Title II--Whole School Reform--language allowing .................
local school districts to use School Improvement
Grants to implement a whole-school reform strategy
for a school using an evidence-based strategy that
ensures whole-school reform is undertaken in
partnership with a strategy developer offering a
whole-school reform program that is based on at
least a moderate level of evidence that the program
will have a statistically significant effect on
student outcomes as defined by the Department's
General Administrative Regulations..................
CORPORATION FOR NATIONAL AND COMMUNITY SERVICE
Social Innovation Fund--including up to 20 percent $80,000,000
set-aside for Pay for Success initiatives and
language directing CNCS to (1) provide renewal
grants to current SIF grantees that are
demonstrating significant interim outcomes but have
not had sufficient time to achieve their program
goals and (2) permit current SIF grantees to be
eligible to apply for additional SIF funds for
projects not currently funded by SIF................
GENERAL PROVISION
Performance Partnership Pilot--language establishing .................
up to 10 Performance Partnership Pilots to improve
outcomes for disconnected youth.....................
[This statement was submitted by Michele Jolin, Managing Partner,
America Achieves.]
______
Prepared Statement of the American Academy of Family Physicians
The American Academy of Family Physicians (AAFP), representing
110,600 family physicians and medical students nationwide, urges the
Senate Appropriations Subcommittee on Labor, Health and Human Services,
and Education to invest in our Nation's primary care physician
workforce in the fiscal year 2015 appropriations bill to promote the
efficient, effective delivery of healthcare by providing these
appropriations for the Health Resources and Services Administration and
the Agency for Healthcare Research and Quality:
--$71 million for Health Professions Primary Care Training and
Enhancement authorized under Title VII, Section 747 of the
Public Health Service Act (PHSA);
--$10 million for Teaching Health Centers development grants (PHSA
Title VII, Sec. 749A);
--$4 million for Rural Physician Training Grants (PHSA Title VII,
Sec. 749B);
--$100 million for the National Health Service Corps (PHSA Sec. 338A,
B, & I);
--$375 million for the Agency for Healthcare Research and Quality
(PHSA Sec. 487(d)(3), SSA Sec. 1142); and
--$3 million for the National Health Care Workforce Commission (ACA
Sec. 5101).
Founded in 1947, the AAFP is dedicated to preserving and promoting
the science and art of family medicine and ensuring high-quality, cost-
effective healthcare for patients of all ages. The AAFP appreciates the
opportunity to comment on the fiscal year 2015 appropriations levels
needed to achieve those important goals.
health resources and services administration (hrsa)
Our Nation faces a shortage of primary care physicians. The total
number of office visits to primary care physicians is projected to
increase from 462 million in 2008 to 565 million in 2025 requiring
nearly 52,000 additional primary care physicians by 2025.\1\ The Health
Resources and Services Administration (HRSA) is the Federal agency
charged with administering the health professions training programs
authorized under Title VII of the Public Health Services Act and first
enacted in 1963. We urge the Committee to restore funding for
discretionary HRSA programs to the fiscal year 2010 level of $7.48
billion in the fiscal year 2015 bill.
---------------------------------------------------------------------------
\1\ Petterson, S, et al. Projecting U.S. Primary Care Physician
Workforce Needs: 2010-2015. Ann Fam Med 2012; vol.10 no. 6:503-509.
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Title VII Health Professions Training Programs.--In the last 50
years, Congress has revised the Title VII authority in order to meet
our Nation's changing healthcare workforce needs. We now face
burgeoning demand for family physicians and must work to increase their
number in the United States. As the only medical specialty society
devoted entirely to primary care, the AAFP is gravely concerned that a
failure to provide adequate funding for the Title VII, Section 747
Primary Care Training and Enhancement (PCTE) program, will destabilize
education and training support for family physicians. Between 1998 and
2008, in spite of persistent primary care physician shortages, family
medicine lost 46 training programs and 390 residency positions, and
general internal medicine lost nearly 900 positions.\2\ A study
published in the Annals of Family Medicine on the impact of Title VII
training programs found that physicians who work with the underserved
in Community Health Centers and National Health Service Corps sites are
more likely to have trained in Title VII-funded programs.\3\ Title VII
primary care training grants are vital to departments of family
medicine, general internal medicine, and general pediatrics; they
strengthen curricula; and they offer incentives for training in
underserved areas. In the coming years, medical services utilization is
likely to rise given the increasing and aging population as well as the
insured status of more people. These demographic trends will exacerbate
family physician shortages. Although PCTE grants are important to
family medicine, there has not been a competitive cycle for these
grants since fiscal year 2010. The AAFP urges the Committee to increase
the level of Federal funding for primary care training to at least $71
million in fiscal year 2015 to allow for a robust new grant cycle to
support family medicine education and training in the new competencies
required to meet the needs of patients of all ages.
---------------------------------------------------------------------------
\2\ Phillips RL and Turner, BJ. The Next Phase of Title VII Funding
for Training Primary Care Physicians for America's Health Care Needs.
Ann Fam Med 2012; vol.10 no. 2:163-168.
\3\ Rittenhouse DR, et al. Impact of Title VII training programs on
community health center staffing and national health service corps
participation. Ann Fam Med 2008; vol. 6 no. 5:397-405.
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Teaching Health Centers.--The AAFP has long called for reforms to
graduate medical education programs to encourage the training of
primary care residents in non-hospital settings where most primary care
is delivered. An excellent first step is the innovative Teaching Health
Centers (THC) program authorized under Title VII, Sec. 749A to increase
primary care physician training capacity that HRSA administers. Federal
financing of graduate medical education has led to training mainly in
hospital inpatient settings even though most patient care is delivered
outside of hospitals in ambulatory settings. The THC program provides
resources to any qualified community based ambulatory care setting that
operates a primary care residency. We believe that this program
requires an investment of $10 million in fiscal year 2015 for planning
grants.
Rural Physician Workforce Needs.--HRSA's Office of Rural Health
focuses on rural health policy issues and administers rural grant
programs. As the medical specialty most likely to enter rural practice,
family physicians recognize the importance of dedicating appropriate
resources to rural health needs. A recent study found that medical
school rural programs have had a significant impact on rural family
physician supply and called for wider adoption of that model to
substantially increase access to care in rural areas compared to a
greater reliance on international medical graduates or unfocused
expansion of traditional medical schools.\4\ HRSA's Rural Physician
Training Grant program will help medical schools recruit students most
likely to practice medicine in rural communities. This program will
help provide rural-focused experience and increase the number of
medical school graduates who practice in underserved rural communities.
The AAFP recommends that the Committee provide $4 million for Rural
Physician Training Grants in fiscal year 2015 as called for in the
President's budget request.
---------------------------------------------------------------------------
\4\ Rabinowitz,HK, et al. Medical School Rural Programs: A
Comparison With International Medical Graduates in Addressing State-
Level Rural Family Physician and Primary Care Supply. Academic
Medicine, Vol. 87, No. 4/April 2012.
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Primary Care in Underserved Areas.--The National Health Service
Corps (NHSC) recruits and places medical professionals in Health
Professional Shortage Areas to meet the need for healthcare in rural
and medically underserved areas. The NHSC offers scholarships or loan
repayment as incentives for physicians to enter primary care and
provide healthcare to Americans in Health Professional Shortage Areas.
By addressing medical school debt burdens, the NHSC also helps to
ensure wider access to medical education opportunities. The President's
budget request includes $810 million for the NHSC, of which $710
million is mandatory funding. If the NHSC is funded at the President's
requested level in fiscal year 2015, underserved patients will benefit
from an NHSC field strength of more than 15,400 primary care clinicians
compared to the fiscal year 2013 field strength of 8,899. The AAFP
supports the President's budget request for this important program and
recommends that the Committee provide an appropriation of $100 million
for the NHSC in fiscal year 2015 to supplement the authorized and
requested mandatory funds.
agency for heatlhcare research and quality (ahrq)
AHRQ is the only Federal agency responsible for generating evidence
to make healthcare safer; better; and more accessible, equitable and
affordable. AHRQ provides the critical evidence reviews that the AAFP
and other physician specialty societies use to produce clinical
practice guidelines. These evidence-informed guidelines are important
to family physicians as well as to patients and their families. AHRQ
takes the results from the NIH whose research restricts subjects to
limit the variables in clinical studies and brings the practical
information to the practicing physicians who treat patients without
those clinical restrictions. ARHQ supports critical primary care
investigations through Practice-based Research Networks that examine
practice transformation, patient quality and safety in non-hospital
settings, multi-morbidity research, as well as mental and behavioral
healthcare in communities and primary care practices. The AAFP asks
that the Committee provide $375 million in base discretionary funding
for AHRQ in fiscal year 2015.
national health care workforce commission
Appointed on September 30, 2010, the 15-member National Health Care
Workforce Commission was intended to serve as a resource with a broad
array of expertise. The Commission was directed to analyze current
workforce distribution and needs; evaluate healthcare education and
training; identify barriers to improved coordination at the Federal,
State, and local levels and recommend ways to address them; and
encourage innovations. There is broad consensus about the waning
availability of primary care physicians in the United States, but
estimates of the severity of the regional and local shortages vary. The
AAFP supports the work of the Commission to analyze primary care
shortages and propose innovations to help produce the physicians that
our Nation needs and will need in the future. We request that the
Committee provide $4 million in fiscal year 2015 so that this important
Commission can finally begin this important work.
______
Prepared Statement of the American Academy of Pediatrics
The American Academy of Pediatrics (AAP), a non-profit professional
organization of 62,000 primary care pediatricians, pediatric medical
subspecialists, and pediatric surgical specialists dedicated to the
health, safety, and well-being of infants, children, adolescents, and
young adults, appreciates the opportunity to submit this statement for
the record in support of strong Federal investments in children's
health in fiscal year 2015 and beyond. AAP urges all Members of
Congress to put children first when considering short and long-term
Federal spending decisions. AAP supports robust investment in programs
that help ensure the health, safety and well-being of children,
including $5 million for the Pediatric Subspecialty Loan Repayment
Program at the Health Resource Services Administration (HRSA), $21
million for the Emergency Medical Services for Children (HRSA), $139
million for the National Center for Birth Defects and Developmental
Disabilities at the Centers for Disease Control and Prevention (CDC),
and $160 million for Polio Eradication and $49 million for the Measles
program within CDC.
Every adult was once a child. Many adult diseases have their
origins in childhood. Early and continued investments in our children's
health are needed to prevent obesity, heart disease, substance use, and
other chronic conditions that threaten America's health and fiscal
solvency. As clinicians we not only diagnose and treat our patients, we
also promote preventive interventions to improve overall health.
Likewise, as policymakers, you have an integral role in ensuring the
health of future generations through adequate and sustained funding of
vital Federal programs.
Pediatric Subspecialty Loan Repayment Program
The United States' supply of pediatric subspecialists is inadequate
to meet children's health needs. Many children must wait more than 3
months for an appointment with a pediatric subspecialist. Approximately
1 in 3 children must travel 40 miles or more to receive care from a
pediatrician certified in adolescent medicine, developmental behavioral
pediatrics, neurodevelopment disabilities, pulmonology, emergency
medicine, nephrology, rheumatology, and sports medicine. This problem
is compounded by the fact that fewer medical residents are choosing
careers in pediatric subspecialties, and the existing subspecialist
workforce continues to age. There is also a significant disparity in
the geographic distribution of pediatric subspecialists across the
country, resulting in many underserved rural and urban areas.
The Pediatric Subspecialty Loan Repayment Program (PSLRP) seeks to
expand children's access to healthcare by creating a more robust
pediatric work force. In the program, eligible participants must agree
to practice full-time for not less than 2 years in a pediatric medical
specialty, surgical specialty, or a child or adolescent mental and
behavioral subspecialty in a health professional shortage area or a
medically underserved area. In return, the program will pay up to
$35,000 in loan repayment for each year of service, for a maximum of 3
years.
Fiscal year 2015 Request: $5 million; fiscal year 2014 Level: Not
Funded.
Emergency Medical Services for Children
Established by Congress in 1984 and last reauthorized in 2010, the
Emergency Medical Services for Children (EMSC) Program is the only
Federal program that focuses specifically on improving the pediatric
components of the emergency medical services (EMS) system. Currently
celebrating its 30th year, the EMSC program has made landmark
improvements to the emergency care delivered to children all across the
Nation. EMSC aims to ensure that state of the art emergency medical
care for the ill and injured child or adolescent is well integrated
into an EMS system. Every State has received EMSC funds, which they
have used to ensure that hospitals and ambulances are properly equipped
to treat pediatric emergencies, to provide pediatric training to
paramedics and first responders, and to improve the systems that allow
for efficient, effective pediatric emergency medical care.
Continued support for EMSC has allowed the program to maintain its
existing activities, improve pediatric capacity and transport of
pediatric patients, and address emerging issues such as pediatric
emergency care readiness and pediatric emergency medical services in
rural and remote areas.
Fiscal year 2015 Request: $21 million; fiscal year 2014 Level:
$20.1 million.
National Center for Birth Defects and Developmental Disabilities
The National Center for Birth Defects and Developmental
Disabilities is a center within CDC that seeks to promote the health of
babies, children, and adults and enhance the potential for full,
productive living. According to the CDC, birth defects affect 1 in 33
babies and are a leading cause of infant death in the United States;
the center has done tremendous work in the way of identifying the
causes of birth defects and developmental disabilities, helping
children to develop and reach their full potential. The center also
conducts important research on fetal alcohol syndrome, infant health,
autism, congenital heart defects, and other conditions like Tourette
Syndrome, Fragile X, Spina Bifida and Hemophilia. NCBDDD has proven to
be an asset to children and their families and supports extramural
research in every State.
Fiscal year 2015 Request: $139 million; fiscal year 2014 Level:
$122.4 million.
Global Health at CDC
The AAP calls on Congress to support and resource Health and Human
Services to implement the recommendations of the National Vaccine
Advisory Committee of the Global Immunizations Working Group on
enhancing the work of the HHS National Vaccine Program in Global
Immunizations. This includes support for HHS' role in building
international cooperation for the common goal of reducing the burden of
vaccine-preventable diseases. HHS has unique and timely opportunities
to eradicate polio, to reduce measles mortality, and to ensure that the
routine immunization systems at the front lines of these efforts are
maintained. The funding that Congress provides to CDC's Global
Immunization account is also necessary to act on the Advisory
Committee's recommendations that HHS enhance its ongoing efforts to
strengthen global immunization systems, enhance global capacity for
vaccine safety monitoring and post-marketing surveillance, build global
immunization research and development capacity, and strengthen
countries' capacity for vaccine decisionmaking.
Since 1988 a coordinated global immunization campaign has reduced
the number of polio cases globally by more than 99 percent, saving more
than 10 million children from paralysis and bringing the disease close
to eradication. Expanded immunization has reduced the global mortality
attributed to measles by 74 percent between 2000 and 2010.
Polio fiscal year 2015 Request: $160 million; fiscal year 2014
Level: $146 million
Measles fiscal year 2015 Request: $49 million; fiscal year 2014
Level: $42.2 million
America's children deserve better
Twenty 2 percent of children in the United States now live in
poverty--up from 17 percent in 2007. Many children suffer from food
insecurity, unstable housing, family dysfunction, abuse and neglect.
Such adverse childhood experiences are linked with ``toxic stress,'' a
biologic phenomenon associated with profound and irreversible changes
in brain anatomy and chemistry that have been implicated in the
development of health-threatening behaviors and medical complications
later in life including drug use, obesity, and altered immune function.
Adults affected by such adverse childhood experiences are more likely
to have experienced school failure, gang membership, unemployment,
violent crime, and incarceration.
Healthier children, healthier future
On behalf of the 75 million American children and their families
that we serve and treat, the Nation's pediatricians expect Congress to
respond to mounting evidence that child health has life-long impacts
and put children first during appropriations negotiations. Investing in
children is not only the right thing to do for the long-term physical,
mental, and emotional health of the population, but is imperative for
the Nation's long-term fiscal health as well. In addition to the
programs we have specifically mentioned in this testimony, Federal
support for children's health programs, such as early brain and child
development, parenting and health education, and preventive health
services, will yield high returns for the American economy. Cuts to
these areas in the short-term will blunt the possible long-term savings
these programs could achieve.
We fully recognize the Nation's fiscal challenges and respect that
difficult budgetary decisions must be made; however, we do not support
funding decisions made at the expense of the health and welfare of
children and families. Rather, a focus on the long-term needs of
children and adolescents will ensure that the United States can compete
in the modern, highly-educated global marketplace. Strong and sustained
financial investments in children's healthcare, research, and
prevention programs will help keep our children healthy and pay
dividends for years to come.
The American Academy of Pediatrics looks forward to working with
Members of Congress to prioritize the health of our Nation's children
in fiscal year 2015 and beyond. If we may be of further assistance
please contact Pat Johnson at the AAP Department of Federal Affairs at
202-347-8600 or pjohnson@aap.org. Thank you for your consideration.
[This statement was submitted by James, Perrin, MD, FAAP,
President, American Academy of Pediatrics.]
______
Prepared Statement of the American Academy of Physician Assistants
On behalf of the more than 95,000 clinically practicing physician
assistants in the United States, the American Academy of Physician
Assistants (AAPA) is pleased to submit comments on fiscal year 2015
appropriations for Physician Assistant (PA) educational programs that
are authorized through Title VII of the Public Health Service (PHS)
Act. AAPA respectfully requests the Senate Appropriations Committee to
approve funding at existing levels for the Title VII health professions
education program--$280,000,000, with an allocation of 15 percent of
the Primary Care Training and Enhancement program line for PA
educational programs.
Federal support for Title VII is authorized through section 747 of
the PHS Act. It is the only continuing Federal funding available to PA
educational programs. Unfortunately, in recent years, PA educational
programs have received reduced support from Title VII funding, which is
designed to educate PAs in primary care and to prepare PAs for practice
in urban or rural medically underserved areas.
This funding is essential to the development and training of the
Nation's health workforce, and is critical to providing continued
access to health services in underserved and minority communities. It
also encourages PAs to return to these environments with the greatest
need after they have completed their educational preparation, being one
of the best recruitment tools to date. According to the Health
Resources and Services Administration (HRSA), 37 percent of PAs
practice in medically underserved counties, including medically
underserved areas and medically underserved populations.
Additionally, Title VII funding has helped PA Programs expand
clinical rotations in rural and underserved areas that have been in
critically short supply and has enhanced primary care curriculum to
better address the needs of disadvantaged populations.
While the purview of the Title VII programs grant funding has
expanded to include assisting returning combat veterans, funding for PA
educational programs has been significantly reduced. Additional
reductions to this budget will disadvantage new PA programs that need
these funds to help with student recruitment, faculty development, and
establishing clinical rotation cites.
Diverse clinical rotation sites and recruitment programs are
critical to PA education and are paramount to the Title VII primary
care medicine program. A review of PA graduates from 1990--2009
demonstrated that PAs who have graduated from PA educational programs
supported by Title VII are 67 percent more likely to be from
underrepresented minority populations and 47 percent more likely to
work in a rural health clinic than graduates of programs that were not
supported by Title VII. We wish to thank the members of this
subcommittee for your historical role in supporting funding for the
health professions programs, and we hope that we can count on your
support to augment funding to these important programs in fiscal year
2015.
Overview of PA Education
The existing 181 accredited PA educational programs are all located
within schools of medicine or health sciences, universities, teaching
hospitals, and the Armed Services. All PA educational programs are
accredited by the Accreditation Review Commission on Education for the
Physician Assistant.
The typical PA program consists of 26 months of instruction, and
the typical student has a bachelor's degree and about 4 years of prior
healthcare experience. The PA curriculum includes 400 hours of basic
sciences and nearly 1,600 hours of clinical medicine. On average,
students devote more than 2,000 hours, or 50 to 55 weeks, to clinical
education, divided between primary care medicine--family medicine,
internal medicine, pediatrics, and obstetrics and gynecology--and
various specialties, including surgery and surgical specialties,
internal medicine subspecialties, emergency medicine, and psychiatry.
After graduating from an accredited PA program, PAs must pass a
national certifying examination developed by the National Commission on
Certification of Physician Assistants and become licensed by the State
to provide medical care.. To maintain certification, PAs must log 100
continuing medical education hours every 2 years, and they must take a
recertification exam every 10 years.
PA Practice
PAs are licensed health professionals who practice medicine as
members of a healthcare team. PAs exercise autonomy in medical
decisionmaking and provide a broad range of medical and therapeutic
services to diverse populations in rural and urban settings. PAs
perform physical examinations, diagnose and treat illnesses, order and
interpret lab tests, assist in surgery, provide patient education and
counseling, and make rounds in nursing homes and hospitals. PAs are
nationally certified and State licensed to practice medicine and
prescribe medication in all fifty States, the District of Columbia, the
Commonwealth of the Northern Mariana Islands, Guam, and the U.S. Virgin
Islands.
PAs in Primary Care
An estimated 30,000 PAs (32 percent of the profession) work in
primary care across the Nation--38.2 percent work in private practice
(multi-and single specialty and solo practices); 23.3 percent in Family
Medicine, 3.0 percent practice in community health centers, 3.3 percent
practice in certified rural health clinics, and 2.7 percent work in a
federally qualified health center.
PAs are also one of three primary care providers who provide
medical care through the National Health Service Corps (NHSC). The NHSC
is an important Federal program with nearly 10,000 healthcare
providers, like PAs, who benefit from the program's loan-forgiveness
and scholarship awards to those providers and students who commit 2
years to provide medical, dental, and mental healthcare in medically
underserved areas.
Additionally, PAs provide medical care in community health centers
(CHCs), some as CHC medical directors. CHCs provide cost-effective
healthcare throughout the country and serve as medical homes for
millions in medically underserved areas. CHCs offer a wide variety of
healthcare services through team-based care, providing high quality
healthcare to CHC patients and significantly reducing medical expenses.
Critical Role of the Title VII PHS Act Programs
According to the Health Resources and Services Administration
(HRSA), an additional 31,000 healthcare providers are needed to
alleviate existing professional shortages. This existing shortage,
combined with faculty shortages across PA education, the need to build
greater diversity among healthcare providers, and an increasingly aging
healthcare workforce, creates challenges in growing the primary
healthcare workforce.
Title VII programs are the only Federal educational programs that
are designed to address the supply and distribution imbalances in the
health professions. Since the establishment of Medicare, the costs of
physician residencies, nurse training, and some allied health
professions training have been paid through Graduate Medical Education
(GME) funding; however, GME has not been available to support PA
education. More importantly, GME was not intended to generate a supply
of providers who are willing to work in the Nation's medically
underserved communities--the purpose of Title VII.
Furthermore, Title VII programs seek to recruit students who are
from underserved minority and disadvantaged populations, which is a
critical step towards reducing persistent health disparities among
certain racial and ethnic U.S. populations. Research shows racial and
ethnic health disparities cost the economy more than $230 billion in
lost productivity and up to $1.24 trillion in indirect costs over 3
years; and studies have found that health professionals from
disadvantaged regions of the country are three to five times more
likely to return to underserved areas to provide care which would help
alleviate the current health disparity crisis in America.
Support for educating PAs to practice in underserved communities is
particularly important given the market demand for PAs. Title VII
funding is a critical link in addressing the natural geographic mal-
distribution of healthcare providers by exposing students to
underserved sites during their training, where they frequently choose
to practice following graduation. Currently, 36 percent of PAs met
their first clinical employer through their clinical rotations.
Supplementary Recommendations on fiscal year 2015 Funding
AAPA urges members of the Appropriations Committee to consider the
inter-dependency of all public health agencies and programs when
determining funding for fiscal year 2015. For instance, while it is
critical, now more than ever, to fund clinical research at the National
Institutes of Health (NIH) and to have an infrastructure at the Centers
for Disease Control and Prevention (CDC) that ensures a prompt response
to an infectious disease outbreak or bioterrorist attack, the good work
of both of these agencies will go unrealized if HRSA is inadequately
funded.
HRSA administers the ``people'' programs, such as Title VII, that
bring the results of cutting edge research at NIH to patients through
providers such as PAs who have been educated in Title VII-funded
programs. Likewise, the CDC is heavily dependent upon an adequate
supply of healthcare providers to be sure that disease outbreaks are
reported, tracked, and contained.
Thank you for the opportunity to present the AAPA's views on fiscal
year 2015 appropriations concerning HRSA's Title VII Health Professions
Program.
[This statement was submitted by Sandy Harding, MSW, Senior
Director, Federal Advocacy.]
______
Prepared Statement of the American Alliance of Museums
Chairman Harkin, Ranking Member Moran, and members of the
Subcommittee, my name is Don Wildman, and for six highly rated seasons,
I've had the extreme honor of hosting a television show, Mysteries at
the Museum (Thursday nights on the Travel Channel), which tells the
stories behind artifacts in museum collections. My testimony today is
presented on behalf of the American Alliance of Museums, the largest
organization of museums and museum professionals in the world, and we
are respectfully asking the Subcommittee to provide $38.6 million for
the Office of Museum Services (OMS) at the Institute of Museum and
Library Services (IMLS), its fully-authorized amount, in fiscal year
2015.
Museums are among our Nation's most popular, most trusted and most
beloved institutions. There are approximately 850 million visits to
American museums each year, more than the attendance for all major
league sporting events and theme parks combined. Museums also spend
over $2 billion on educational programming, and a total of $21 billion
in their local economies. Clearly museums are economic engines and job
creators.
IMLS is the primary Federal agency that supports the museum field,
and OMS awards grants to help museums digitize, enhance and preserve
their collections; provide teacher training; and create innovative,
cross-cultural and multi-disciplinary programs and exhibits for schools
and the public.
It's no surprise that the appropriations bill that funds education
supports this agency, because museums are indeed key education
providers. They design exhibitions, educational programs, classroom
kits, and online resources in coordination with State, local and common
core curriculum standards in math, science, art, literacy, language
arts, history, civics and government, economics and financial literacy,
geography, and social studies. Museums also offer experiential learning
opportunities, STEM education, mentoring, and job preparedness.
Whatever education looks like in the future, one component will
certainly be the development of a core set of skills: critical
thinking; the ability to synthesize information; and the ability to
innovate, to be creative and to collaborate. Museums are uniquely
situated to help learners develop these core skills.
In late 2010, legislation to reauthorize IMLS for 5 years was
enacted (by voice vote in the House and by unanimous consent in the
Senate). The bipartisan reauthorization included several provisions
proposed by the museum field, including enhanced support for
conservation and preservation, emergency preparedness and response and
statewide capacity building. The reauthorization also specifically
supports efforts at the State level to leverage museum resources,
including statewide needs assessments and the development of State
plans to improve and maximize museum services throughout the State. The
bill (now Public Law 111-340) authorized $38.6 million for the IMLS
Office of Museum Services to meet the growing demand for museum
programs and services. The fiscal year 2014 appropriation of
$30,131,000 represents a nearly 15 percent decrease from the fiscal
year 2010 appropriation of $35,212,000.
Grants are awarded in every State, but perhaps the best way to
demonstrate the importance of the IMLS Office of Museum Services is to
highlight just a few of the grants awarded in 2013 to museums in States
represented by Subcommittee members:
Public Programs and Energy Efficiency--Reiman Gardens, Iowa State
University of Science and Technology (Ames, IA) was awarded $95,040 to
develop a comprehensive landscape design, architectural, and
engineering plan. Designs will address community programming needs,
visitor experience, facilities and maintenance needs, and energy
efficiency standards.
Recognizing Excellence--The National Czech & Slovak Museum &
Library (Cedar Rapids, IA) received $5,000 and the 2013 National Medal
for Museum and Library Service. When the worst disaster in State
history destroyed entire areas of Cedar Rapids in 2008, the National
Czech & Slovak Museum & Library was instrumental in leading its
devastated ethnic neighborhood in recovery, rebuilding, and
revitalization.
Youth Programs and Collections Care--The Kansas African American
Museum (Wichita, KS) was awarded $149,950 to create a public history
youth program in partnership with the University of Kansas Libraries,
serving 60 youth and training 25 volunteer docents annually. The museum
is also using the grant to upgrade its collections management system
and to address its most critical collections care and security needs.
Environmental Science--The Calvert Marine Museum Society (Solomons,
MD) was awarded $142,500 to develop and install an exhibit on the
ecosystem of the Patuxent River and Chesapeake Bay. They are partnering
with local schools and community groups to facilitate lifelong learning
of scientific concepts and environmental stewardship.
Collections Care--The Birmingham Civil Rights Institute
(Birmingham, AL) was awarded $74,277 to safeguard its collections to
ensure that they will be available for use by current and future
students, the general public, researchers and staff.
STEM Education--The University of Alabama/Alabama Museum of Natural
History (Tuscaloosa, AL) was awarded $99,998 to create the Discovery
Learning Lab to give middle and high school-aged students access to
``geek'' mentors who will guide them in explorations of digital
technologies not readily available at home or school in low-income
areas. This program exposes teens to STEM disciplines, skills,
activities, and software at the lab and in a cyberspace environment.
Science and Ocean Literacy--The Seattle Aquarium (Seattle, WA) was
awarded $103,821 to design, implement, and evaluate an aquarium
classroom program. The museum will develop the program in cooperation
with practicing scientists, emphasizing both the scientific process and
content based on sea otter and ocean acidification research. The
project will also produce materials to help interpret its findings both
in the museum and in the larger community.
Cultural Identity--The Wing Luke Museum of the Asian Pacific
American Experience (Seattle, WA) was awarded $150,000 to produce a
newly designed tour program that emphasizes community storytelling and
audience engagement. The Chinatown International District is Seattle's
lowest-income neighborhood, and will benefit from increased museum
attendance and enhanced community involvement.
Recognizing Excellence--The Delta Blues Museums (Clarksdale, MS)
was awarded $5,000 and the 2013 National Medal for Museum and Library
Service for its work celebrating and nurturing this American art form.
Participants young and old, from diverse economic and ethnic
backgrounds participate in the museum's popular music classes while its
travelling trunk exhibit inspires blues appreciation nationwide.
3D Printing--The Art Institute of Chicago (Chicago, IL) was awarded
$25,000 to reach audiences of all ages by using 3D printing
technologies. The museum will evaluate the potential impact of this
technology on engagement with museum collections, and will develop
guidelines to be shared with other museums and educators.
Collections Care--The Hermann-Grima and Gallier Historic Houses
(New Orleans, LA) were awarded $22,830 to develop a plan to improve
their interior environments to better conserve collections and the
historical buildings.
Professional Development--The Newport Art Museum and Art
Association (Newport, RI) was awarded $24,028 for an initiative that
orients high school students to cultural administration careers through
classroom learning, site visits, and mentoring. The grant will allow
the museum to expand the reach of this initiative and establish paid
internships for students, helping them develop their interests and
build valuable skills for the future.
Mobile Science Classroom--The Discovery Center at Murfree Spring
(Murfreesboro, TN) was awarded $103,849 to convert a school bus into a
mobile science classroom for elementary school students.
Digitization--The Country Music Hall of Fame (Nashville, TN) was
awarded $150,000 for a digitization initiative to preserve and increase
access to the museum's unparalleled collection.
Collections Care--The University Museum, University of Arkansas
(Fayetteville, AR) was awarded $31,464 to improve its zoology
collection and make it more accessible to researchers.
I am aware that this subcommittee wants to ensure that its
investments in Federal grant programs have measurable and significant
impact. I believe that the grants listed above demonstrate the value of
investing in museums as a means of investing in our communities.
Further, it should be noted that each time a Federal grant is awarded,
additional local and private funds are also leveraged. Two-thirds of
IMLS grantees report that their Museums for America grant positioned
the museum to receive additional private funding.
Even the most ardent deficit hawks view the IMLS grant-making
process as a model for the Nation. Each grant is selected through a
rigorous, peer-reviewed process. And due to the large number of grant
applications and the limited funds available, many highly-rated grant
proposals go unfunded each year.
--Only 28 percent of Museums for America/Conservation Project Support
project proposals were funded;
--Only 15 percent of National Leadership project proposals were
funded;
--Only 15 percent of Sparks Ignition Grants for Museums project
proposals were funded;
--Only 46 percent of Native American/Hawaiian Museum Services project
proposals were funded; and
--Only 31 percent of African American History and Culture project
proposals were funded.
On a final and personal note, the interviews I conduct with museum
professionals for my television show have confirmed for me what I've
known since I was a kid--that museums are cool, really cool. If there's
one thing Americans young and old love, it's a good story about America
and that's what museums have to offer.
American museums do this job and they do it extremely well. They
collect the stories by preserving and curating the objects--documents,
inventions, clothing, paintings, sculptures and skeletons--which
explain who we've been, who we are and how we survive.
I was raised outside of Philadelphia. Without museums, I'd have
never walked through the left ventricle of the super-sized heart in the
Ben Franklin Institute. But for the Academy of Natural Sciences, I'd
have never understood the difference between a stegosaurus and a
triceratops. I wouldn't have had that first encounter with Vincent van
Gogh at the Philadelphia Museum of Art. It's impossible to imagine my
childhood without museums or to imagine my adulthood. They're our
lifeline to the past--and an inspiration for the future.
We hope you'll support our cause, and provide at least $38.6
million in fiscal year 2015 for the Office of Museum Services (OMS) at
the Institute of Museum and Library Services (IMLS), its fully-
authorized amount.
[This statement was submitted by Don Wildman, Host, Travel
Channel's Mysteries at the Museum, American Alliance of Museums.]
______
Prepared Statement of the American Association for Dental Research
On behalf of the 3,500 individual and 44 institutional members of
the American Association for Dental Research (AADR), I am pleased to
submit testimony describing AADR's fiscal year 2015 requests, which
include $32 billion for the National Institutes of Health (NIH) and
$425 million for the National Institute of Dental and Craniofacial
Research (NIDCR). These funding recommendations represent the true
needs of the research community while at the same time taking into
consideration the continued tight budget climate dictated by the caps
established by the Bipartisan Budget Act of 2013. I want to emphasize
the recent Federal austerity measures--sequestration, government
shutdown and the continued uncertainty--had a significant impact on our
members, universities and research supported via NIDCR. In actual
dollars, NIDCR lost $23 million in funding in fiscal year 2013 and only
$10 million was restored in fiscal year 2014. However, when adjusted
for inflation, the NIDCR budget is 22 percent, or $75 million, less
than it was in 2002, resulting in the lowest number of research grants
awarded in 13 years. This creates an atmosphere that is very
discouraging to new scientific investigators whose research proposals
are good enough to be funded but were not because of the budget cuts.
We are at risk of losing them and their promising research ideas--ideas
that might lead to significant advances in dental, oral health and
craniofacial health.
The downward trend in lost purchasing power is particularly
troubling because the improvements in oral health during the last half
century are largely credited to research supported by NIDCR. It is
therefore reasonable to assume that these declines in funding will slow
or limit future breakthroughs. NIDCR is the largest institution in the
world dedicated exclusively to research to improve dental, oral and
craniofacial health. The health of the mouth and surrounding
craniofacial (skull and face) structures is central to a person's
overall health and well-being. Left untreated, oral diseases and poor
oral conditions go untreated, make it difficult to eat, drink, swallow,
smile, talk and maintain proper nutrition. Scientists also have
discovered important linkages between gum disease, or periodontal
disease, and heart disease, stroke, diabetes and pancreatic cancer.
In spite of these improvements, however, treating oral health
conditions is costly with $110.9 billion in expenditures on dental
services in 2012. While tooth decay and gum disease remain the most
prevalent, complete tooth loss, oral cancer, and craniofacial
congenital anomalies, like cleft lip and palate are also health and
economic burdens to the American people. Moreover, oral health
disparities exist for many racial and ethnic groups. By providing $425
million in fiscal year 2015, NIDCR, dental, oral and craniofacial
researchers will be able to build upon the gains of the past decades,
creating less invasive, cost effective and more efficient ways to
improve oral health. Below are some examples highlighting the important
work supported by NIDCR:
--Point of Care Diagnostics: Salivary diagnostics are measures that
draw and analyze saliva to test for conditions such as HIV,
HPV, substance abuse, caries, periodontitis and oral cancer.
Through the work and support of NIDCR over the last decade,
these diagnostics are showing great promise in screening for
diabetes, heart disease, lung cancer, ovarian cancer and
pancreatic cancer. Salivary diagnostics only require
withdrawing saliva, unlike traditional methods that rely on
withdrawing blood or on doing tissue biopsy. As a result,
salivary diagnostics are less invasive. In addition, they are
relatively inexpensive and have the potential of showing more
immediate results which is particularly beneficial when results
are urgently needed.
--Periodontal Disease: Periodontal or gum disease is a chronic
inflammatory disease that affects the gum tissue and bone
supporting the teeth. Approximately 47.2 percent of Americans
have mild, moderate or severe periodontitis. If left untreated,
periodontal disease can lead to tooth loss. Research has shown
that periodontal disease is associated with other chronic
inflammatory diseases such as diabetes and cardiovascular
disease. To date, the prevention of gum disease has been
limited to successful oral hygiene and regular professional
care. Recently, however, scientists reported the discovery of
resolvins, a biologically active product that has the potential
to protect against soft tissue and bone loss associated with
gum disease. More research is needed to further intensify
efforts to apply the novel biological approach to treating
inflammatory diseases.
--Dental Caries: Dental caries, or tooth decay, remains the most
prevalent chronic disease in both children and adults resulting
in a substantial economic and health burden to the American
people. Although caries has significantly decreased for most
Americans over the past four decades, disparities remain among
some population groups. In addition, this downward trend has
recently reversed for young children. More research is needed
to enhance efforts to address dental caries.
--HPV-Related Oral Cancer: This type of cancer is caused by the human
papillomavirus (HPV). It is predicted that this cancer will be
the most common HPV-related cancer by 2020. HPV-induced oral
cancers among men are likely to exceed HPV-induced cervical
cancers within the next 8 years. In fact, HPV is now causing
more oral cancers than smoking. Identifying the presence of HPV
in a mouth swab or a blood draw does not definitively indicate
the impending presence of cancer. As a result, more research is
needed for the early detection of HPV-related oral cancer, and
for the development of therapies that would lead to the
prevention of cancer progression.
--Evidenced-Based Practice: NIDCR recently awarded a seven-year grant
that consolidates its dental practice-based research network
initiative into a unified nationally coordinated effort. The
consolidated initiative, the National Dental Practice Based
Research Network (NDPBRN) is headquartered at the University of
Alabama at Birmingham School of Dentistry. A dental practice-
based research network is an investigative union of practicing
dentists and academic scientists. The network provides
practitioners with an opportunity to propose or participate in
research studies that address daily issues in oral healthcare.
These studies help to expand the profession's evidence base and
further refine care.
--Cleft Lip and/or Cleft Palate--Craniofacial anomalies such as cleft
lip and/or cleft palate (CLP) are among the most common birth
defects. Both genetic and environmental factors contribute to
oral clefts. Cleft lip is an abnormality in which the lip does
not completely form during fetal development and cleft palate
occurs when the roof of the mouth does not fully close, leaving
an opening that can extend into the nasal cavity. Genome-wide
association studies (GWAS) of cleft lip and/or cleft palate
supported by NIDCR are providing important new leads about the
role genetic factors and gene-environment interactions play in
the development of these conditions. In addition, a DNA
sequencing study is underway to identify less common genetic
variants that influence the risk of developing cleft lip and/or
cleft palate. NIDCR will continue to support the best science
to understand craniofacial structures and anomalies more
completely.
Our members remain concerned that unless Congress fully reverses
the erosion caused by sequestration our ability to attract the next
generation of scientists will stall; our standing as a world leader in
science will decline; and innovation necessary to push the boundaries
of research will be stymied. Accordingly, I strongly urge you work in a
bipartisan manner to prioritize funding for dental, oral and
craniofacial research this year and undo sequestration permanently in
fiscal year 2016 and beyond. Future advances in healthcare depend on a
sustained investment in basic research to identify the fundamental
causes and mechanisms of disease, accelerate technological development
and discovery, and ensure a robust pipeline of creative and skillful
biomedical researchers. For these reasons, I implore you to work in a
bipartisan manner and provide funding increases for NIH and NIDCR in
fiscal year 2015.
In addition to the NIH, AADR members care deeply about the Title
VII Health Resources and Services Administration (HRSA) programs
training the dental health workforce; the Centers for Disease Control
and Prevention (CDC) Division of Oral Health's public health prevention
efforts; data from the National Center for Health Statistics (NCHS) and
the Agency for Healthcare Research & Quality (AHRQ). Please support
AADR's funding recommendations for these agencies depicted in the chart
below.
[In millions of dollars]
----------------------------------------------------------------------------------------------------------------
Fiscal year Fiscal year Fiscal year Fiscal year Fiscal year
Agency 2012 2013 2014 2015 PBR 2015 AADR
----------------------------------------------------------------------------------------------------------------
NIH..................................... 30,702 29,070 30,020 30,220 32,000
NIDCR................................... 410.3 386.8 397.10 397.13 425.0
NCATS................................... 574.8 542.1 633.3 657.5 657.5
AHRQ.................................... 405.1 429.4 364 334 375
CDC, Oral Health........................ 14.6 13.8 15.8 15.8 19.0
CDC, NCHS............................... 153.8 153.8 155.3 155.4 182
HRSA, Title VII Oral Health............. 32.4 30.7 32 32 32.4
----------------------------------------------------------------------------------------------------------------
[This statement was submitted by Timothy DeRouen, PhD, President,
American Association for Dental Research.]
______
Prepared Statement of the American Association of Colleges of Nursing
As the national voice for baccalaureate and graduate nursing
education, the American Association of Colleges of Nursing (AACN)
represents 750 schools of nursing that educate over 450,000 students
and employ more than 17,000 full-time faculty members. Collectively,
these institutions produce approximately half of our Nation's
Registered Nurses (RNs) and all nurse faculty, Advanced Practice
Registered Nurses (APRNs), and nurse scientists. AACN requests that
nursing education, research, and practice are strongly supported in
fiscal year 2015 through an investment of $251 million for HRSA's
Nursing Workforce Development programs (authorized under Title VIII of
the Public Health Service Act [42 U.S.C. 296 et seq.]), $150 million
for the National Institute of Nursing Research (NINR) within NIH, and
$20 million in authorized funding for the Nurse-Managed Health Clinics
(NMHCs) (Title III of the Public Health Service Act). These levels will
ensure that our Nation's nurses are prepared to care for the growing
number of patients requiring a complex range of healthcare services.
demand for nursing care
The Bureau of Labor Statistics' (BLS) publication Employment
Projections for 2012-2022 anticipates significant growth in the nursing
workforce from 2.71 million in 2012 to 3.24 million by 2022. This surge
in demand translates to 526,800 nurses, or an increase of 19.4 percent.
When considering the number of job openings for RNs due to the
increasing demand for nursing care and replacements in an aging nursing
workforce, more than one million nurses will be needed by 2022. In
fact, according to the The U.S. Nursing Workforce: Trends in Supply and
Education released by HRSA in 2013, over the next 10 to 15 years, the
nearly 1 million RNs older than age 50--about one-third of the current
workforce--will reach retirement age. The retirement decisions of these
experienced RNs may be influenced by the pace of economic recovery and
have the potential to create a serious deficit in the nursing pipeline.
Moreover, the BLS projects a need for 47,600 additional Nurse
Practitioners, Certified Registered Nurse Anesthetists, and Certified
Nurse-Midwives (or APRNs) to meet the call for more primary and acute
care services, particularly due to the aging baby boomer population and
increased access to health insurance coverage. The BLS' Occupational
Outlook Handbook reported that there will be a 31 percent increase in
this sector of the workforce between 2012-2022. Investments are
necessary to educate the RNs and APRNs who will provide the care that
Americans need now and in the future.
title viii nursing workforce development programs
For fifty years, the Nursing Workforce Development programs,
authorized under Title VIII of the Public Health Service Act, have
helped build the supply and distribution of qualified nurses to meet
our Nation's healthcare needs. Between fiscal year 2006 and 2012 alone,
the Title VIII programs supported over 450,000 nurses and nursing
students, as well as numerous academic nursing institutions and
healthcare facilities. The programs bolster nursing education at all
levels, from entry-level preparation through graduate study, and
provide support to educate nurses for practice in rural and medically
underserved communities. Today, the Title VIII programs are essential
to ensuring that the demand for nursing care is met by supporting
future practicing nurses and the faculty who educate them.
However, faculty vacancies have repeatedly been cited as a
fundamental obstacle to maximizing nursing school enrollment. According
to the American Association of Colleges of Nursing's 2013-2014
Enrollment and Graduations in Baccalaureate and Graduate Programs in
Nursing survey, 78,089 qualified applications were turned away from
nursing schools in 2013 alone. A primary barrier to accepting all
qualified students at nursing colleges and universities continues to be
a shortage of faculty. To counter this disparity, the Title VIII Nurse
Faculty Loan Program aids in increasing nursing school enrollment
capacity by supporting students pursuing graduate education, provided
they serve as faculty for 4 years after graduation.
The Title VIII programs also increase the number of practicing
nurses entering the pipeline and the placement of these nurses into
medically-underserved areas. AACN's Title VIII Student Recipient
Survey, which gathers information annually about Title VIII funding and
outcomes related to nursing education and career trajectories, provides
evidence on the effectiveness of these programs in recruiting more
students to the nursing profession and, more importantly, practice in
rural and underserved areas. Results of the 2013-2014 Title VIII
Student Recipient Survey included responses from 850 students who noted
that these programs played a critical role in funding their nursing
education. The survey showed that for 67 percent of respondents, Title
VIII funding impacted their decision to enter nursing school. Moreover,
76 percent of the students receiving Title VIII funding are able to
attend school full-time through this Federal support. By facilitating
full-time education, the Title VIII programs are helping to ensure that
students enter the workforce without delay. In addition, personal
testimony of several survey respondents revealed that many Title VIII
recipients intend to practice in the community in which they were
educated--a direct State investment. AACN respectfully requests $251
million for the Nursing Workforce Development programs authorized under
Title VIII of the Public Health Service Act in fiscal year 2015.
national institute of nursing research: advancing nursing science
The healthcare community is investigating methods to improve the
delivery of high-quality care in a financially sustainable manner. As
one of the 27 Institutes and Centers at the NIH, the NINR is dedicated
to providing the healthcare workforce with evidence-based knowledge and
the resources needed to accomplish this goal. Research conducted at
NINR addresses disease prevention and health promotion efforts that
improve quality of life and alleviate financial burden on individuals
and the system. Specific areas targeted by NINR include chronic illness
management, disease prevention, pain management, and care-giver
support. Nursing research is a critical compliment to biomedical
research as it investigates how to prevent disease and promote healthy
living. Moreover, research funded at NINR helps to integrate biology
and behavior as well as design new technology and tools. At a time when
healthcare needs are changing, nursing care must be firmly grounded in
nursing science.
NINR also allocates a generous 6 percent of its overall budget to
the education and training of nurse researchers, many of whom dually
serve as nurse faculty within our Nation's nursing schools. Increased
investments must be made in the scientists that improve healthcare
delivery through their groundbreaking discoveries. AACN respectfully
requests $150 million for the NINR in fiscal year 2015.
nurse-managed health clinics: expanding access to care
Managed by APRNs and staffed by an interdisciplinary health
provider team, NMHCs provide necessary primary care services to
medically-underserved communities and serve as critical access points
to keep patients out of the emergency room, saving the healthcare
system millions of dollars annually. NMHCs provide care to vulnerable
populations in a host of regions of the country, including rural
communities, Native American reservations, senior citizen centers,
elementary schools, and urban housing developments. These communities
are the most susceptible to developing chronic illnesses that create
heavy financial burdens on patients and the healthcare system. NMHCs
aim to reduce disease and create healthier communities through improved
patient education and health practices.
Often associated with a school, college, university, department of
nursing, federally qualified health center, or independent nonprofit
healthcare agency, NMHCs also serve as clinical education training
sites for students of nursing, medicine, physical therapy, social work,
and ancillary healthcare services. Moreover, by serving as clinical
training sites, NMHCs help foster interprofessional education and
practice so that patients receive individualized care from an array of
providers. According to AACN, the lack of clinical training sites is
often pointed to as a top reason for turning away qualified
applications in nursing programs. AACN respectfully requests $20
million for the Nurse-Managed Health Clinics in fiscal year 2015.
AACN recognizes that the Subcommittee and Congress will need to
make difficult decisions regarding appropriations for fiscal year 2015.
AACN respectfully requests Congress to continue a strong investment in
the health of our Nation by providing $251 million for the Title VIII
Nursing Workforce Development programs, $150 million for the National
Institute of Nursing Research, and $20 million for Nurse-Managed Health
Clinics in fiscal year 2015. If you have any questions, or if AACN can
be of assistance, please contact AACN's Director of Government Affairs
and Health Policy, Dr. Suzanne Miyamoto, at Smiyamoto@aacn.nche.edu.
______
Prepared Statement of the American Association of Colleges of
Osteopathic Medicine
The American Association of Colleges of Osteopathic Medicine
(AACOM) strongly supports restoring funding for discretionary Health
Resources and Services Administration (HRSA) programs to the fiscal
year 2010 level of $7.48 billion; funding of $520 million for HRSA's
Title VII and VIII programs under the Public Health Service Act; $10
million minimally for the Teaching Health Center Graduate Medical
Education (THCGME) Development Grants; sustainment of student
scholarship and loan repayment programs; $4 million for the Rural
Physician Training grants; $3 million for the National Health Care
Workforce Commission; $32 billion for the National Institutes of Health
(NIH); and $375 million in base discretionary funding, restoring the
base to fiscal year 2011 levels for the Agency for Healthcare Research
and Quality (AHRQ).
AACOM represents the 30 accredited colleges of osteopathic medicine
in the United States. These colleges are accredited to deliver
instruction at 42 teaching locations in 28 States. In the 2013-2014
academic year these colleges are educating over 23,000 future
physicians--more than 20 percent of U.S. medical students. Six of the
colleges are publicly controlled; 24 are private institutions.
The Title VII health professions education programs, authorized
under the Public Health Service Act and administered through HRSA,
support the training and education of health practitioners to enhance
the supply, diversity, and distribution of the healthcare workforce,
acting as an essential part of the healthcare safety net and filling
the gaps in the supply of health professionals not met by traditional
market forces. Title VII and Title VIII nurse education programs are
the only Federal programs designed to train clinicians in
interdisciplinary settings to meet the needs of special and underserved
populations, as well as increase minority representation in the
healthcare workforce.
As demand for health professionals increase in the face of
impending shortages combined with faculty shortages across health
professions disciplines, racial and ethnic disparities in healthcare, a
growing, aging population, and the anticipated demand for increased
access to care, these needs strain an already fragile healthcare
system. AACOM appreciates the investments that have been made in these
programs, and we urge the Subcommittee to fund $520 million for the
Title VII and VIII programs to include support for the following
programs in order to include: the Primary Care Training and Enhancement
(PCTE) Program, the Health Careers Opportunity Program (HCOP), the
Centers of Excellence (COE), the Geriatric Education Centers (GECs) and
the Area Health Education Centers (AHECs). We strongly oppose the
Administration's proposals to eliminate funding for AHECs and the HCOP.
AACOM has serious concerns with the Administration's budget request
that would cut nearly $15 billion from Medicare graduate medical
education (GME). Because GME funding is critical to addressing the
existing physician workforce shortage and ensuring patient access to
our Nation's healthcare, AACOM believes that current GME funding should
not be sacrificed and simply shifted to other healthcare workforce
programs of importance. Instead, additional investments in GME are
critical to an already insufficiently-funded system.
AACOM strongly supports the continuation of the THCGME Program,
which provides funding to support primary care medical and dental
residents training in community-based settings. THCs currently train
more than 350 medical and dental residents and are providing more than
700,000 primary care visits in underserved rural and urban communities.
This program will also provide long-term benefits. According to the
HRSA, physicians who train in THCs are three times more likely to work
in such centers and more than twice as likely to work in underserved
areas as physicians who train in other settings. The THCGME Program's
5-year authorization expires in fiscal year 2015, but the recruitment
of new residents is being impacted now. We support an investment of $10
million in fiscal year 2015 for development grants minimally.
Through scholarships and loan repayment, the National Health
Service Corps (NHSC) supports the recruitment and retention of primary
care clinicians to practice in underserved communities. Approximately
50 million Americans live in communities with a shortage of health
professionals, lacking adequate access to primary care. The self-
reported average medical education debt of graduates of colleges of
osteopathic medicine who borrowed to attend medical school has
increased by almost $85,000 in the last decade. Today, there are more
than 23,000 students enrolled at osteopathic medical schools across the
Nation. Recent graduates report graduating with an average medical
education debt of $211,423.
Today, there are nearly 8,900 NHSC members providing culturally
competent care to more than 9.3 million people. Care is provided at
5,100 NHSC-approved healthcare sites in urban, rural, and frontier
areas. In addition to Corps providers currently providing care, nearly
1,100 students, residents, and health providers receive scholarships or
participate in the Student to Service Loan Repayment program to prepare
to practice, which provides loan repayment assistance to medical
students in their last year of education in return for their commitment
to practice. AACOM appreciates the Administration's continued
investment in the NHSC and strongly supports the preservation of
student scholarship and loan repayment programs. Furthermore, we
encourage congressional authorizers and appropriators to work together
before current mandatory funding for the NHSC expires at the end of
fiscal year 2015. This critical funding works to address the primary
care workforce shortage and advances innovative models of service.
HRSA's Rural Physician Training grants will help rural-focused
training programs recruit and graduate students most likely to practice
medicine in underserved rural communities. HRSA's Office of Rural
Health Policy analyzes potential effects of policy on residents of
rural communities and administers grant programs designed to build
healthcare capacity at both the local and State levels. Health
professions workforce shortages are exacerbated in rural areas, where
communities struggle to attract and keep well-trained providers.
According to HRSA, approximately 65 percent of primary care health
professional shortage areas are rural. AACOM supports the President's
fiscal year 2015 budget request of $4 million for the Rural Physician
Training grants.
The National Health Care Workforce Commission was designed to
develop and evaluate training activities to meet demand for healthcare
workers. Without funding, the Commission cannot identify barriers that
may create and exacerbate workforce shortages and improve coordination
on the Federal, State, and local levels. Having this type of
coordinating body in place is becoming more critical as more Americans
have insurance coverage and as the population ages, requiring access to
care. As the United States struggles to address healthcare provider
shortages in certain specialties and in rural and underserved areas,
the country lacks a defined policy to address these critical. For these
reasons, AACOM recommends that $3 million be appropriated to fund the
Commission so it can begin its important work.
Research funded by the NIH leads to important medical discoveries
regarding the causes, treatments, and cures for common and rare
diseases, as well as disease prevention. These efforts improve our
Nation's health and save lives. To maintain a robust research agenda,
further investment will be needed. AACOM recommends $32 billion for the
NIH.
In today's increasingly demanding and evolving medical curriculum,
there is a critical need for more research geared toward evidence-based
osteopathic medicine. AACOM believes that it is vitally important to
maintain and increase funding for biomedical and clinical research in a
variety of areas related to osteopathic principles and practice,
including osteopathic manipulative medicine and comparative
effectiveness. In this regard, AACOM encourages support for the NIH's
National Center for Complementary and Alternative Medicine (NCCAM) to
continue fulfilling this essential research role.
AHRQ supports research to improve healthcare quality, reduce costs,
advance patient safety, decrease medical errors, and broaden access to
essential services. AHRQ plays an important role in producing the
evidence base needed to improve our Nation's health and healthcare. The
incremental increases for AHRQ's Patient Centered Health Research
Program in recent years will help AHRQ generate more of this research
and expand the infrastructure needed to increase capacity to produce
this evidence; however, more investment is needed. AACOM recommends
$375 million in base discretionary funding, restoring the base to
fiscal year 2011 levels for the AHRQ. This investment will preserve
AHRQ's current programs while helping to restore its critical
healthcare safety, quality, and efficiency initiatives.
AACOM is grateful for the opportunity to submit its views and looks
forward to continuing to work with the Subcommittee on these important
matters.
[This statement was submitted by Stephen C. Shannon, D.O., M.P.H.,
President and Chief Executive Officer, American Association of Colleges
of Osteopathic Medicine.]
______
Prepared Statement of the American Association of Immunologists
The American Association of Immunologists (AAI), the world's
largest professional society of research scientists and physicians who
study the immune system, respectfully submits this testimony regarding
fiscal year 2015 appropriations for the National Institutes of Health
(NIH). AAI recommends an appropriation of at least $32 billion for NIH
for fiscal year 2015 to support important ongoing research, fund a
reasonable number of outstanding new grant applications, and restore
NIH funding to a level that can sustain a robust and dynamic biomedical
research enterprise in the United States.
nih's crucial role in advancing biomedical research
NIH is essential to the advancement of biomedical research in the
United States, where virtually all biomedical scientists rely on NIH
leadership and funding.\1\ Academic scientists, many of whom conduct
research while teaching the next generation of doctors and scientists,
depend on NIH grants to support their research at universities,
colleges and research institutions all around the country. NIH
intramural scientists require funding to do their own research as well
as collaborate with their private sector colleagues.\2\ And scientists
employed by industry, who generally do not receive NIH grants or
awards, depend on NIH-funded scientific discoveries to develop products
that bring research to the bedside. A strong NIH budget, therefore, is
essential to all sectors of the U.S. biomedical research enterprise,
and has enabled NIH to remain the key international leader influencing
biomedical research around the globe.
---------------------------------------------------------------------------
\1\ After a highly competitive peer review process, which includes
comprehensive review by panels of extramural scientists, NIH awards
more than 80 percent of its $30.1 billion budget to ``more than
300,000 researchers at more than 2,500 universities, medical schools,
and other research institutions in every State and around the world.''
About 10 percent of its budget supports the work of the approximately
6,000 scientists who work in NIH's own laboratories. (http://
www.nih.gov/about/budget.htm).
\2\ AAI is concerned that a Federal policy limits government
scientists' ability to attend privately sponsored scientific meetings
and conferences. (See http://www.hhs.gov/travel/policies/
2012_policy_manual.pdf AAI believes that ``the rules have had an
unintended and deleterious effect . . . [and] made government
scientists feel cut off from the rest of the scientific community,
wreaked havoc with their ability to fulfill professional commitments,
and undermined the morale of some of the government's finest minds.''
Testimony (Amended) of Lauren G. Gross, J.D., on behalf of The American
Association of Immunologists (AAI), Submitted to the Senate Homeland
Security and Governmental Affairs Committee for the Hearing Record of
January 14, 2014: ``Examining Conference and Travel Spending Across the
Federal Government'' (http://aai.org/Public_Affairs/Docs/2014/
AAI_Testimony_to_Senate_HSGAC_01142014.pdf).
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nih budget woes slow research and threaten u.s. preeminence
The slow growth of the NIH budget in recent years, exacerbated by
the impact of biomedical research inflation,\3\ has significantly
reduced NIH's purchasing power, and in turn, the purchasing power of
its grantees. According to the Congressional Research Service (CRS),
``[i]n constant 2003 dollars, fiscal year 2014 funding is 22 percent
lower than the fiscal year 2003 level.'' \4\ How many avenues of
research have not been followed because of this reduction? How many
potential treatments and cures have been delayed or not discovered?
These are questions that cannot be answered definitively, but we do
know that NIH budget reductions have already caused real and lasting
damage: the loss of grant funding, even among the most highly qualified
scientists; the closure of labs; the termination or interruption of
important research; and the emigration of talented scientists to other
countries. And we do know that many scientists are spending too much
time in a constant chase for funding, rather than conducting research
and mentoring the Nation's future researchers, inventors and
innovators. These budget woes threaten America's preeminence in
advancing basic biomedical research, discovering urgently needed
treatments and cures, and ``growing'' brilliant young scientists.
---------------------------------------------------------------------------
\3\ The Biomedical Research and Development Price Index (BRDPI)
``is developed each year for NIH by the Bureau of Economic Analysis of
the Department of Commerce. It reflects the increase in prices of the
resources needed to conduct biomedical research, including personnel,
services, supplies, and equipment. It indicates how much the NIH budget
must change to maintain purchasing power.'' Johnson, Judith A., ``A
History of NIH Funding: Fact Sheet,'' Congressional Research Service,
R43341, p. 2 (2014).
\4\ Ibid.
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research on the immune system: essential to our health, crucial to our
future
The immune system is the body's primary defense against viruses,
bacteria, and parasites that cause disease in millions of people every
year. When the immune system is operating properly, it provides
powerful protection against a wide variety of illnesses, including
cancer, Alzheimer's disease, and cardiovascular disease. The immune
system can, however, perform poorly, leaving the body vulnerable to
infections, including influenza, HIV/AIDS, tuberculosis, malaria, and
the common cold. It can also become overactive, damaging normal organs
and tissues, and causing autoimmune diseases, such as allergy, asthma,
inflammatory bowel disease, lupus, multiple sclerosis, rheumatoid
arthritis, and type 1 diabetes. Research scientists and clinicians are
working to harness this powerful system to protect people and animals
from infectious diseases, cancer, and many other illnesses, and to
protect against natural or man-made infectious organisms (including
plague, smallpox and anthrax) that could be used for bioterrorism.\5\
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\5\ NIH should robustly fund and primarily rely on individual
investigator-initiated research, in which researchers working in
institutions across the Nation submit applications to, and following
independent peer review, receive grants from, NIH. Biomedical
innovation and discovery are less likely to be achieved through ``top-
down'' science, in which the government specifies the type of research
it wishes to fund.
---------------------------------------------------------------------------
recent immunological advances and their promise for tomorrow
1. Cancer Immunotherapies: Offering Hope of Conquering Cancer
NIH-funded scientists recently identified inhibitory receptors
which suppress immune cell activation. Blocking these receptors can
allow the immune system to destroy tumor cells.\6\ Today, therapeutics
targeted against inhibitory receptors like CTLA4 are undergoing
rigorous clinical trials against a variety of cancers. The success
rates for these therapies have been astounding and unprecedented: for
example, rates of tumor regression in patients with metastatic melanoma
have increased from 10 percent to 50 percent.\7\ With this level of
success, immunotherapy is one of the most exciting and promising areas
of cancer treatment.
---------------------------------------------------------------------------
\6\ Couzin-Frankel, Jennifer. ``Cancer Immunotherapy.'' Science
342.6165 (2013): 1432-433.
\7\ Wolchok, J. D. et al. ``Nivolumab plus Ipilimumab in Advanced
Melanoma.'' N Engl J Med 369.2 (2013): 122-33.
---------------------------------------------------------------------------
2. Early Antiretroviral Therapy: Eliminating HIV, Ending AIDS?
NIH-funded researchers have discovered that early administration of
antiviral medication, known as anti-retroviral therapy (ART), can have
lasting effects on an HIV-infected patient's long-term prognosis. In
one study,\8\ an infant born to an HIV-infected mother began receiving
ART within hours of birth. The infant tested positive for HIV and
continued treatment for 18 months. Despite the HIV diagnosis and
subsequent discontinuation of ART, the child remained virus-free 1 year
later. A second baby with a similar history also showed an absence of
HIV.\9\ Together with several additional unconfirmed cases of babies
``cured'' of HIV infection, these findings offer hope to the 250,000
babies born each year infected with HIV.\10\
---------------------------------------------------------------------------
\8\ Deborah, Persaud et al. ``Absence of Detectable HIV-1 Viremia
after Treatment Cessation in an Infant.'' N Engl J Med 369 (2013):
1828-835.
\9\ Conference on Retroviruses and Opportunistic Infections, March
3--6, 2014, Boston, MA (http://www. croi2014.org/) (See also http://
www.nytimes.com/2014/03/06/health/second-success-raises-hope-for-a-way-
to-rid-babies-of-hiv.html).
\10\ A clinical trial following 60 babies born infected with HIV
and being treated with antiretroviral medication will begin soon. (See
http://www.nytimes.com/2014/03/06/health/second-success-raises-hope-
for-a-way-to-rid-babies-of-hiv.html) A second study found that adult
HIV-infected patients who were treated with ART within 4 months of
infection display significantly improved response to treatment. [See
Le, Tuan, et al. ``Enhanced CD4+ T-Cell Recovery with Earlier HIV-1
Antiretroviral Therapy.'' N Engl J Med 368 (2013): 218-30].
---------------------------------------------------------------------------
3. Gut (Intestinal) Bacteria: The Microbiome Role in Autoimmune Disease
NIH-funded research has shown that gut bacteria (the intestinal
``microbiome''), which aid in food digestion, may impact the
development of autoimmune diseases, including rheumatoid arthritis,
type 1 diabetes, multiple sclerosis and inflammatory bowel
disorders.\11\ Current research is exploring changes in gut bacteria
from diet, hormones, antibiotics, and infections, and the effect of gut
bacteria based therapeutics [for example, the ingestion of healthy gut
bacteria (probiotics) in yogurt]. One study involving fecal
transplantation (which includes the transfer of intestinal bacteria
from one person to another) has found that such transplantation in pill
form is well tolerated and is 98-100 percent efficacious in curing
infections with Clostridium difficile, a bacterium linked to 14,000
diarrheal deaths in the U.S. per year.\12\
---------------------------------------------------------------------------
\11\ Sorini, C., and M. Falcone. ``Shaping the (auto)immune
Response in the Gut: The Role of Intestinal Immune Regulation in the
Prevention of Type 1 Diabetes.'' Am J Clin Exp Immunol 2.2 (2013): 156-
71.
\12\ Infectious Diseases Society of America. ``Fecal Transplant
pill knocks out recurrent C. diff infection,'' Science Daily (2013)
(See http://www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html).
---------------------------------------------------------------------------
4. RSV Vaccine: Saving Infants' Lives
Millions of infants are hospitalized and 160,000 children die each
year each from pneumonia and other lung diseases caused by respiratory
syncytial virus (RSV).\13\ Until recently, however, a vaccine for RSV
has been elusive. In an important breakthrough, scientists at the NIH
discovered antibodies--protective molecules produced by the immune
system--that helped identify a key protein for use in vaccine
development.\14\ The NIH scientists were then able to engineer this
protein and demonstrate its ability to produce a strong protective
immune response against RSV in animals.\15\ This molecule is expected
to be ready soon for testing in humans. Importantly, the approach
developed in this case can be applied to vaccine design for numerous
other viruses, such as HIV, hepatitis C, dengue, and West Nile viruses,
that have evaded the body's protective immune responses, and will
provide insight into how viruses evade the immune system.
---------------------------------------------------------------------------
\13\ Couzin-Frankel, Jennifer. ``Cancer Immunotherapy.'' Science
342.6165 (2013): 1432-433.
\14\ McLellan, J. S. et al. ``Structure of RSV Fusion Glycoprotein
Trimer Bound to a Pre-fusion Specific Neutralizing Antibody.'' Science
340.6136 (2013): 1113-117.
\15\ McLellan, J. S. et al. ``Structure-Based Design of a Fusion
Glycoprotein Vaccine for Respiratory Syncytial Virus.'' Science
342.6158 (2013): 592-98.
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conclusion
AAI thanks the members and staff of the subcommittee for their
ongoing, strong bipartisan support for biomedical research, and
recommends an appropriation of at least $32 billion for NIH for fiscal
year 2015 to fund important ongoing research, strengthen the biomedical
research enterprise, and ensure that the brightest scientists,
trainees, and students are able to pursue careers in biomedical
research in the United States.
[This statement was submitted by Elizabeth J. Kovacs, Ph.D.,
American Association of Immunologists.]
______
Prepared Statement of the American Association of Nurse Anesthetists
FISCAL YEAR 2015 APPROPRIATIONS REQUEST SUMMARY
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
Fiscal year Fiscal year
2013 actual 2014 enacted AANA fiscal year 2015 request
----------------------------------------------------------------------------------------------------------------
HHS/HRSA/BHPr Title 8 Advanced Education $2.25 $2.25 $4 million for nurse
Nursing, Nurse Anesthetist Education Reserve. anesthesia education
Total for Advanced Education Nursing, from 59.4 61.581 83.925 million for advanced
Title 8. education nursing
----------------------------------------------------------------------------------------------------------------
Title 8 HRSA BHPr Nursing Education Programs.. 220.4 223.841 251
----------------------------------------------------------------------------------------------------------------
About the American Association of Nurse Anesthetists (AANA) and
Certified Registered Nurse Anesthetists (CRNAs)
The AANA is the professional association for more than 47,000 CRNAs
and student nurse anesthetists, representing over 90 percent of the
nurse anesthetists in the United States. Today, CRNAs deliver
approximately 34 million anesthetics to patients each year in the U.S.
CRNA services include administering the anesthetic, monitoring the
patient's vital signs, staying with the patient throughout the surgery,
and providing acute and chronic pain management services. CRNAs provide
anesthesia for a wide variety of surgical cases and in some States are
the sole anesthesia providers in almost 100 percent of rural hospitals,
affording these medical facilities obstetrical, surgical, and trauma
stabilization, and pain management capabilities. CRNAs work in every
setting in which anesthesia is delivered, including hospital surgical
suites and obstetrical delivery rooms, ambulatory surgical centers
(ASCs), pain management units and the offices of dentists, podiatrists
and plastic surgeons.
Nurse anesthetists are experienced and highly trained anesthesia
professionals whose record of patient safety is underscored by
scientific research findings. The landmark Institute of Medicine report
To Err is Human found in 2000 that anesthesia was 50 times safer then
than in the 1980s. (Kohn L, Corrigan J, Donaldson M, ed. To Err is
Human. Institute of Medicine, National Academy Press, Washington DC,
2000.) Though many studies have demonstrated the high quality of nurse
anesthesia care, the results of a new study published in Health Affairs
led researchers to recommend that costly and duplicative supervision
requirements for CRNAs be eliminated. Examining Medicare records from
1999-2005, the study compared anesthesia outcomes in 14 States that
opted-out of the Medicare physician supervision requirement for CRNAs
with those that did not opt out. (To date, 17 States have opted-out.)
The researchers found that anesthesia has continued to grow more safe
in opt-out and non-opt-out States alike. (Dulisse B, Cromwell J. No
Harm Found When Nurse Anesthetists Work Without Supervision By
Physicians. Health Aff. 2010;29(8):1469-1475.)
CRNAs provide the lion's share of anesthesia care required by our
U.S. Armed Forces through active duty and the reserves, staffing ships,
remote U.S. military bases, and forward surgical teams without
physician anesthesiologist support. In addition, CRNAs predominate in
rural and medically underserved areas, and where more Medicare patients
live (Government Accountability Office. Medicare and private payment
differences for anesthesia services. GAO-07-463, Washington DC, Jul.
27, 2007. http://www.gao.gov/products/GAO-07-463).
Importance of and Request for HRSA Title 8 Nurse Anesthesia
Education Funding
Our profession's chief request of the Subcommittee is for $4
million to be reserved for nurse anesthesia education and $83.925
million for advanced education nursing from the HRSA Title 8 program,
out of a total Title 8 budget of $251 million. We request that the
Report accompanying the fiscal year 2014 Labor-HHS-Education
Appropriations bill include the following language: ``Within the
allocation, the Committee encourages HRSA to allocate funding at least
at the fiscal year 2014 level for nurse anesthetist education.'' This
funding request is justified by the safety and value proposition of
nurse anesthesia, and by anticipated growth in demand for CRNA services
as baby boomers retire, become Medicare eligible, and require more
healthcare services. In making this request, we associate ourselves
with the request made by The Nursing Community with respect to Title 8
and the National Institute of Nursing Research (NINR) at the National
Institutes of Health.
The Title 8 program, on which we will focus our testimony, is
strongly supported by members of this Subcommittee in the past, and is
an effective means to help address nurse anesthesia workforce demand.
In expectation for dramatic growth in the number of U.S. retirees and
their healthcare needs, funding the advanced education nursing program
at $83.925 million is necessary to meet the continuing demand for
nursing faculty and other advanced education nursing services
throughout the U.S.,. The program funds competitive grants that help
enhance advanced nursing education and practice, and traineeships for
individuals in advanced nursing education programs. It also targets
resources toward increasing the number of providers in rural and
underserved America and preparing providers at the master's and
doctoral levels, thus increasing the supply of clinicians eligible to
serve as nursing faculty, a critical need.
Demand remains high for CRNA workforce in clinical and educational
settings. A 2007 AANA nurse anesthesia workforce study found a 12.6
percent CRNA vacancy rate in hospitals and a 12.5 percent faculty
vacancy rate. The supply of clinical providers has increased in recent
years, stimulated by increases in the number of CRNAs trained. From
2002-2012, the annual number of nurse anesthesia educational program
graduates increased from 1,362 to 2,469, according to the Council on
Accreditation of Nurse Anesthesia Educational Programs (COA). The
number of accredited nurse anesthesia educational programs grew from 85
to 114. We anticipate increased demand for anesthesia services as the
population ages, the number of clinical sites requiring anesthesia
services grows, and a portion of the CRNA workforce retires.
The capacity of our 114 nurse anesthesia educational programs to
educate qualified applicants is limited by the number of faculty, the
number and characteristics of clinical practice educational sites, and
other factors--and they continue turning away hundreds of qualified
applicants. A qualified applicant to a CRNA program is a bachelor's
educated registered nurse who has spent at least 1 year serving in an
acute care healthcare practice environment. They are prepared in nurse
anesthesia educational programs located all across the country,
including Arkansas, California, Connecticut, Georgia, Kentucky,
Maryland, New York, Ohio, and Tennessee. To meet the nurse anesthesia
workforce challenge, the capacity and number of CRNA schools must
continue to grow and modernize with the latest advancements in
simulation technology and distance learning consistent with improving
educational quality and supplying demand for highly qualified
providers. With the help of competitively awarded grants supported by
Title 8 funding, the nurse anesthesia profession is making significant
progress, but more is required.
This progress is extremely cost-effective from the standpoint of
Federal funding. Anesthesia can be provided by nurse anesthetists,
physician anesthesiologists, or by CRNAs and anesthesiologists working
together. Of these, the nurse anesthesia practice model is by far the
most cost-effective, and ensures patient safety. (Hogan P et al. Cost
effectiveness analysis of anesthesia providers. Nursing Economic$, Vol.
28 No. 3, May-June 2010, p. 159 et seq.) Nurse anesthesia education
represents a significant educational cost-benefit for competitively
awarded Federal funding in support of CRNA educational programs.
Support for Safe Injection Practices and the Alliance for Injection
Safety
As a leader in patient safety, the AANA has been playing a vigorous
role in the development and projects of the Alliance for Injection
Safety, intended to reduce and eventually eliminate the incidence of
healthcare facility acquired infections. In the interest of promoting
safe injection practice, and reducing the incidence of healthcare
facility acquired infections, we associate ourselves with the AIS
recommendation.
Support Effective Implementation of Provider Non-Discrimination
AANA applauds the Committee for including report language in its
fiscal year 2014 bill directing the Administration to implement the
provision in a manner consistent with its intent, to promote
competition, quality and choice in a way that supports access and
controls costs.
The AANA is firmly committed to supporting competition, access and
choice within the healthcare delivery system and has been working to
ensure effective implementation of the Federal provider
nondiscrimination provision in the Patient Protection and Affordable
Care Act (ACA). This provision, which prohibits health plans from
discriminating against qualified licensed healthcare professionals
solely on the basis of their licensure, went into effect on January 1,
2014.
Proper implementation of the ACA provider nondiscrimination
provision is crucial because health plans today may discriminate
against whole classes of healthcare professionals based solely on their
licensure or certification, limiting or denying patient choice and
access to beneficial, safe and cost-efficient healthcare professionals,
impairing competition, patient access to care, and optimal healthcare
delivery. For example, a commercial carrier in South Carolina stated in
its policy manual that it will not reimburse CRNAs for monitored
anesthesia care (MAC), but that it will pay anesthesiologists for these
same services. Not only does such a policy impair patient access to
care provided by CRNAs; it expressly impairs competition and choice and
contributes to unjustifiably higher healthcare costs without improving
quality or access to care.
The AANA urges the committee to include the following report
language with the House Appropriation, Health and Human Services,
Education and Related Agencies Subcommittee legislation. The Committee
directs HHS to continue its work with the Departments of Labor and
Treasury to implement the provider non discrimination law to reflect
the original Congressional intent of the provision.
[This statement was submitted by Dennis Bless, CRNA, MS, President,
American Association of Nurse Anesthetists.]
______
Prepared Statement of the American Association of Nurse Practitioners
On behalf of the American Association of Nurse Practitioners
(AANP), the largest full service professional organization representing
the 189,000 nurse practitioners across the country, we would like to
submit the below noted funding requests for fiscal year 2015. Nurse
Practitioners (NPs) have been providing primary, acute, and specialty
healthcare to patients of all ages for nearly half a century. As you
know, in addition to treating acute and chronic illnesses of patients
coming to them for care, they emphasize health promotion and disease
prevention in all their undertakings. This includes assessments,
ordering, performing, supervising and interpreting diagnostic and
laboratory tests, making diagnoses, initiating and managing treatment
which includes prescribing medications as well as non-pharmacologic
treatments, counselling and educating patients, their families and
communities. They are the healthcare providers of choice for millions
of patients; in fact last year they conducted over 900 million patient
visits across the Nation.
The vast majority of nurse practitioners throughout the United
States are primary care providers. Eighty 8 percent are prepared to be
primary care clinicians and nearly seventy percent are currently
practicing in a primary care setting. As clinicians that blend clinical
expertise in diagnosing and treating health conditions with an added
emphasis on disease prevention and health promotion, NPs bring a
comprehensive perspective to healthcare that enhances health and well-
being among their patients. Given the demand for primary care
providers, NPs are and will continue to fill a critical role in the
American healthcare system. Likewise the need to create and fund more
nurse managed clinics is critical. As the need for primary care
services grows, funding such clinics becomes increasingly necessary.
The need to adequately prepare nurse practitioners and facilitate the
high quality outcomes of these clinics is clear. Equally clear is the
need for funding assistance to nurse practitioner educational programs,
students and nurse managed clinics. We are anxious to include among our
ranks, students who would not be able to enter our programs without
assistance as well as clinic sites that serve as clinical education
sites and meet the unmet healthcare needs of a wide variety of
populations throughout the country. Therefore we ask that at the very
least the following funding be appropriated:
For fiscal year 2015, AANP respectfully requests $251 million for
the Health Resources and Services Administration's (HRSA) Nursing
Workforce Development programs (authorized under Title VIII of the
Public Health Service Act [42 U.S.C. 296 et seq.]), $150 million for
the National Institute of Nursing Research (NINR) within the National
Institutes of Health (NIH), and $20 million in authorized funding for
the Nurse-Managed Health Clinics (Title III of the Public Health
Service Act). These investments made through the appropriation process
will help to ensure that our Nation's population receives high quality,
cost effective healthcare.
AANP would like to work closely with the committee on areas of
common interest. We are happy to serve as a resource to the committee
as you make decisions about these investments. We thank you for the
opportunity to share our concerns with you and look forward to
continuing to work with you and your staff on issues affecting our
profession. Please contact AANP's Federal Government Affairs department
at: governmentaffairs@aanp.org should you have any questions or need
further information.
______
Prepared Statement of the American Congress of Obstetricians and
Gynecologists
The American Congress of Obstetricians and Gynecologists (ACOG),
representing 58,000 physicians and partners in women's healthcare, is
pleased to offer this statement to the Senate Committee on
Appropriations, Subcommittee on Labor, Health and Human Services, and
Education. We thank Chairman Harkin, and the entire Subcommittee for
the opportunity to provide comments on some of the most important
programs to women's health.
Today, the U.S. lags behind many other Nations in healthy births.
ACOG's Making Obstetrics and Maternity Safer (MOMS) Initiative would
help improve maternal and infant health through Federal research
investments, including comprehensive data collection and surveillance,
biomedical research, and translating research into evidence-based care
for women and babies. We urge you to make funding of the following
programs and agencies a top priority in fiscal year 2015.
Data Collection and Surveillance at the Centers for Disease Control and
Prevention (CDC)
In order to conduct robust research, uniform, accurate and
comprehensive data and surveillance are critical. The National Center
for Health Statistics is the Nation's principal health statistics
agency and collects State data from records like birth certificates
that give us raw, vital statistics. Information from birth and death
certificates is key to gathering vital information about both mother
and baby during pregnancy and labor and delivery. Uniform, accurate
data collection depends on all States and territories using electronic
birth and death records based on the 2003 US-standard birth and death
certificates, yet 4 States are still not using the electronic birth
registries and 12 States are still not using the electronic death
registries.
States not using the standard records likely underreport maternal
and infant deaths and complications from childbirth; causes of these
deaths remain unknown. Previous appropriations have helped increase the
number of States using electronic birth and death registries, but NCHS
needs increased resources to help enroll the remaining States, and to
improve the accuracy of birth and death data, including through linking
data from Electronic Health Records to State vital records systems. For
fiscal year 2015, ACOG requests $182 million for the National Center
for Health Statistics, $5 million of which we urge you to designate to
modernize the National Vitals Statistics System, helping States update
their birth and death records systems.
The Pregnancy Risk Assessment Monitoring System (PRAMS) at CDC
extends beyond vital statistics and surveys new mothers on their
experiences and attitudes during pregnancy, with questions on a range
of topics, including what their insurance covered, whether they had
stressful experiences during pregnancy, when they initiated prenatal
care, and what kinds of questions their doctor covered during prenatal
care visits. By identifying trends and patterns in maternal health, CDC
researchers and State health departments are better able to identify
behaviors and environmental and health conditions that may lead to
preterm births. Only 40 States use the PRAMS surveillance system today.
ACOG requests adequate funding to expand PRAMS to all U.S. States and
territories.
Biomedical Research at the National Institutes of Health (NIH)
Biomedical research is critically important to understanding the
causes of maternal and infant mortality and morbidity, and developing
effective interventions to lower the incidence of mortality and
morbidity. The National Institute on Child Health and Human
Development's (NICHD's) 2012 Scientific Vision identified the most
promising research opportunities for the next decade. Goals include
determining the complex causes of prematurity and developing evidence-
based measures for its prevention within the next 10 years,
understanding the long term health implications of assisted
reproductive technology, and understanding the role of the placenta in
fetal health outcomes. The placenta, one of the least studied human
organs, is essential to the viability and proper growth of the fetus.
NICHD's Human Placenta Project will help discover the causes of
placental failures, and ultimately ways to prevent failure and improve
maternal and fetal birth outcomes.
Another major issue that merits attention is that of clinical
trials involving pregnant women. Pregnant women have historically been
excluded from most research trials due to concern that trial
participation could harm the fetus. Although there has been substantial
progress in the inclusion of women in federally funded research,
pregnant women are still excluded, even from research that would
advance our knowledge of medical conditions and treatments in
pregnancy. Mindful of the important considerations of clinical trials
on pregnant women, we support establishment of a Federal work group to
propose how clinical research might be done appropriately in this area.
Adequate levels of research require a robust research workforce.
The years of training combined with uncertainty in getting grant
funding are huge disincentives for students considering a career in
bio-medical research. This has resulted in a huge gap between the too-
few women's reproductive health researchers being trained and the
immense need for research. We urge continued investments in the Women's
Reproductive Health Research (WRHR) Career Development program,
Reproductive Scientist Development Program (RSDP), and the Building
Interdisciplinary Research Careers in Women's Health (BIRCWH) programs
to address the shortfall of women's reproductive health researchers.
ACOG supports a minimum of $32 billion for NIH and $1.37 billion within
that funding request for NICHD in fiscal year 2015.
Public Health Programs at the Health Resources and Services
Administration (HRSA) and the Centers for Disease Control and
Prevention (CDC):
Projects at HRSA and CDC are integral to translating research
findings into evidence-based practice changes in communities. Where NIH
conducts research to identify causes of maternal and infant mortality
and morbidity, CDC and HRSA help ensure those research findings lead to
improved maternal and infant health outcomes.
Maternal Child Health Block Grant (HRSA): The Maternal Child Health
Block Grant at HRSA is the only Federal program that exclusively
focuses on improving the health of mothers and children. State and
territorial health agencies and their partners use MCH Block Grant
funds to reduce infant mortality, deliver services to children and
youth with special healthcare needs, support comprehensive prenatal and
postnatal care, screen newborns for genetic and hereditary health
conditions, deliver childhood immunizations, and prevent childhood
injuries.
These early healthcare services help keep women and children
healthy, eliminating the need for later costly care. Every $1 spent on
preconception care for a woman with diabetes can save up to $5.19 by
preventing costly complications. Over $90 million has been cut from the
Block Grant since 2003. ACOG requests $639 million for the Block Grant
in fiscal year 2015 to maintain its current level of services.
Title X Family Planning Program (HRSA): Family planning and
interconception care are essential to helping ensure healthy women and
healthy pregnancies. The Title X Family Planning Program provides
services to more than 5 million low income men and women who may not
otherwise have access to these services. Title X clinics accounting for
$3.4 billion in healthcare savings in 2008 alone. ACOG supports $327
million for Title X in fiscal year 2015 to sustain its level of
services.
Fetal Infant Mortality Review (HRSA): HRSA's Healthy Start Program
promotes community-based programs to reduce infant mortality and racial
disparities. These programs are encouraged to use the Fetal and Infant
Mortality Review (FIMR) which brings together ob-gyn experts and local
health departments to address local issues contributing to infant
mortality. Today, more than 220 local programs in 42 States find FIMR a
powerful tool to help reduce infant mortality and address issues
related to preterm delivery. For over 20 years, ACOG has partnered with
the Maternal and Child Health Bureau to sponsor the National FIMR
Program. ACOG supports $0.5 million in fiscal year 2015 for HRSA to
increase the number of Healthy Start programs that use FIMR.
Maternal Health Initiative (HRSA): The Maternal Child Health Bureau
launched the Maternal Health Initiative to foster the notion of
``healthy moms make healthy babies.'' As part of this effort, ACOG has
convened the National Partnership on Maternal Safety to identify key
factors to reduce maternal morbidity and mortality. ACOG requests at a
minimum level funding for MCHB to advance this important work.
Safe Motherhood, Maternity and Perinatal Collaboratives (CDC): The
Safe Motherhood Initiative at CDC works with State health departments
to collect information on pregnancy-related deaths, track preterm
births, and improve maternal outcomes. Through Safe Motherhood, CDC
funds State-based Maternity and Perinatal Collaboratives that improve
birth outcomes by encouraging use of evidence-based care, including
reducing early elective deliveries. Through the Ohio Perinatal Quality
Collaborative, started in 2007 with funding from CDC, 21 OB teams in 25
hospitals have significantly decreased early non-medically necessary
deliveries, in accordance with ACOG guidelines, reducing costly and
dangerous pre-term births. Avalere estimated that reducing early
elective can save from $2.4 million to $9 million a year. The PREEMIE
Reauthorization Act, enacted in 2013, authorizes funding to increase
the number of States receiving assistance for perinatal collaboratives.
ACOG urges you to re-instate the pre-term birth sub-line as authorized
by PREEMIE and provide an additional $16 million to Safe Motherhood to
implement PREEMIE and help States expand or establish maternity
perinatal care collaboratives.
Again, we would like to thank the Committee for commitment to
improving women's health, and we urge you to fund programs we've
identified in our MOMS Initiative in fiscal year 2015.
______
Prepared Statement of the American College of Physicians
The American College of Physicians (ACP) is pleased to submit the
following statement for the record on its priorities, as funded under
the U.S. Department of Health & Human Services, for fiscal year 2015.
ACP is the largest medical specialty organization and the second-
largest physician group in the United States. ACP members include
137,000 internal medicine physicians (internists), related
subspecialists, and medical students. Internal medicine physicians are
specialists who apply scientific knowledge and clinical expertise to
the diagnosis, treatment, and compassionate care of adults across the
spectrum from health to complex illness. As the Subcommittee begins
deliberations on appropriations for fiscal year 2015, ACP is urging
funding for the following proven programs to receive appropriations
from the Subcommittee:
--Title VII, Section 747, Primary Care Training and Enhancement, at
no less than $71 million;
--National Health Service Corps, $810 million in funding, including
the $310 million in enhanced funding through the Community
Health Centers Fund;
--National Health Care Workforce Commission, $3 million;
--Agency for Healthcare Research and Quality, $375 million; and
--Centers for Medicare and Medicaid Services, Program Management for
Marketplaces, $629 million.
The United States is facing a growing shortage of physicians in key
specialties, most notably in general internal medicine and family
medicine--the specialties that provide primary care to most adult and
adolescent patients. With enactment of the Affordable Care Act (ACA),
we expect the demand for primary care services to increase with the
addition of 25 million Americans receiving access to health insurance,
including an additional 13 million under Medicaid/CHIP, once the law is
fully implemented. With increased demand, current projections indicate
there will be a shortage of over 45,000 primary care physicians by
2020, growing to a shortage of over 65,000 primary care physicians by
2025. (AAMC Center for Workforce Studies with the Lewin Group. The
Impact of Health Care Reform on the Future Supply and Demand of
Physicians Updated Projections Through 2025. June 2010. Accessed at:
https://www.aamc.org/download/158076/data/updated_projections_through_
2025.pdf). Without critical funding for vital workforce programs, this
physician shortage will only grow worse. A strong primary care
infrastructure is an essential part of any high-functioning healthcare
system, with over 100 studies showing primary care is associated with
better outcomes and lower costs of care (http://www.acponline.org/
advocacy/where_we_stand/policy/primary_shortage.pdf).
The health professions' education programs, authorized under Title
VII of the Public Health Service Act and administered through the
Health Resources and Services Administration (HRSA), support the
training and education of healthcare providers to enhance the supply,
diversity, and distribution of the healthcare workforce, filling the
gaps in the supply of health professionals not met by traditional
market forces, and are critical in helping institutions and programs
respond to the current and emerging challenges of ensuring that all
Americans have access to appropriate and timely health services. Within
the Title VII program, we urge the Subcommittee to fund the Section
747, Primary Care Training and Enhancement program at $71 million, in
order to maintain and expand the pipeline for individuals training in
primary care. The Section 747 program is the only source of Federal
training dollars available for general internal medicine, general
pediatrics, and family medicine. For example, general internists, who
have long been at the frontline of patient care, have benefitted from
Title VII training models emphasizing interdisciplinary training that
have helped prepare them to work with other health professionals, such
as physician assistants, patient educators, and psychologists. Without
a substantial increase in funding, for the fourth year in a row, HRSA
will not be able to carry out a competitive grant cycle for physician
training; the Nation needs new initiatives supporting expanded training
in multi-professional care, the patient-centered medical home, and
other new competencies required in our developing health system.
The College urges $810 million in funding for the National Health
Service Corps (NHSC), as requested in the President's fiscal year 2015
budget; this amount includes the $310 million in enhanced funding the
Health and Human Services Secretary has been given the authority to
provide to the NHSC through the Community Health Centers Fund. Since
the enactment of the ACA, the NHSC has awarded over $1 billion in
scholarships and loan repayment to healthcare professionals to help
expand the country's primary care workforce and meet the healthcare
needs of underserved communities across the country. With field
strength of nearly 9,000 clinicians, NHSC members are providing
culturally competent care to more than 10.4 million people at nearly
14,000 NHSC-approved healthcare sites in urban, rural, and frontier
areas. The increase in funds would expand NHSC field strength to 15,000
and would serve the needs of more than 16 million patients, helping to
address the health professionals' workforce shortage and growing
maldistribution. The programs under NHSC have proven to make an impact
in meeting the healthcare needs of the underserved, and with increased
appropriations, they can do more.
We urge the Subcommittee to fully fund the National Health Care
Workforce Commission, as authorized by the ACA, at $3 million. The
Commission is authorized to review current and projected healthcare
workforce supply and demand and make recommendations to Congress and
the Administration regarding national healthcare workforce priorities,
goals, and polices. Members of the Commission have been appointed, but
have not begun work due to a lack of funding. The College believes the
Nation needs a comprehensive workforce policy founded on sound research
to determine the Nation's current and future needs for physicians by
specialty and geographic areas; the work of the Commission is
imperative to ensure Congress is creating the best policies for our
Nation's needs.
The Agency for Healthcare Research and Quality (AHRQ) is the
leading public health service agency focused on healthcare quality.
AHRQ's research provides the evidence-based information needed by
consumers, clinicians, health plans, purchasers, and policymakers to
make informed healthcare decisions. The College is dedicated to
ensuring AHRQ's vital role in improving the quality of our Nation's
health and recommends a budget of $375 million. This amount will allow
AHRQ to help providers help patients by making evidence-informed
decisions, fund research that serves as the evidence engine for much of
the private sector's work to keep patients safe, make the healthcare
market place more efficient by providing quality measures to health
professionals, and ultimately, help transform health and healthcare.
Finally, ACP supports $629 million in funding for the Centers for
Medicare and Medicaid Services, Program Management for Marketplaces as
requested in the President's fiscal year 2015 budget in order to carry
out its duties as necessary. Such funding would allow the Federal
Government to continue to administer the insurance marketplaces as
authorized by the ACA if a State has declined to establish an exchange
that meets Federal requirements. CMS now manages and operates some or
all marketplace activities in over 30 States. If the Subcommittee
decides to deny the requested funds, it will be much more difficult for
the Federal Government to operate and manage a federally-facilitated
exchange in those States, raising questions about where and how their
residents would obtain and maintain coverage. It is ACP's belief that
all legal Americans--regardless of income level, health status, or
geographic location--must have access to affordable health insurance.
In conclusion, the College is keenly aware of the fiscal pressures
facing the Subcommittee today, but strongly believes the United States
must invest in these programs in order to achieve a high performance
healthcare system and build capacity in our primary care workforce and
public health system. The College greatly appreciates the support of
the Subcommittee on these issues and looks forward to working with
Congress as you begin to work on the fiscal year 2015 appropriations
process.
______
Prepared Statement of the American College of Preventive Medicine
The American College of Preventive Medicine (ACPM) urges the Senate
Labor, Health and Human Services, Education, and Related Agencies
Appropriations Subcommittee to reaffirm its support for training
preventive medicine physicians and other public health professionals by
providing $10 million in fiscal year 2015 for preventive medicine
residency training under the public health and preventive medicine line
item in Title VII of the Public Health Service Act. We further
respectfully request that funds allocated for ``public health and
preventive medicine'' be separated into two distinct line items, with
separation of funds for preventive medicine residency training from
other funds allocated to the ``public health and preventive medicine''
line-item. In conjunction, ACPM also supports the recommendation of the
Health Professions and Nursing Education Coalition of $520 million in
fiscal year 2015 to support all health professions and nursing
education and training programs authorized under Titles VII and VIII of
the Public Health Service Act.
In today's healthcare environment, the tools and expertise provided
by preventive medicine physicians play an integral role in ensuring
effective functioning of our Nation's public health system. These tools
and skills include the ability to deliver evidence-based clinical
preventive services, expertise in population-based health sciences, and
knowledge of the social and behavioral determinants of health and
disease. These are the tools employed by preventive medicine physicians
who practice at the health system level where improving the health of
populations, enhancing access to quality care, and reducing the costs
of medical care are paramount. As the body of evidence supporting the
effectiveness of clinical and population-based interventions continues
to expand, so does the need for specialists trained in preventive
medicine.
Organizations across the spectrum have recognized the growing
demand for preventive medicine professionals. The Institute of Medicine
released a report in 2007 calling for an expansion of preventive
medicine training programs by an ``additional 400 residents per year,''
and the Accreditation Council on Graduate Medical Education (ACGME)
recommends increased funding for preventive medicine residency training
programs. Additionally, the Association of American Medical Colleges
released statements in 2011 that stressed the importance of
incorporating behavioral and social sciences in medical education as
well as announcing changes to the Medical College Admission Test that
would test applicants on their knowledge in these areas. Such measures
strongly indicate increasing recognition of the need to take a broader
view of health that goes beyond just clinical care--a view that is a
unique focus and strength of preventive medicine residency training.
In fact, preventive medicine is the only one of the 24 medical
specialties recognized by the American Board of Medical Specialties
that requires and provides training in both clinical and population-
based medicine. Preventive medicine residency training programs provide
a blueprint on how to train our future physician workforce; physicians
trained to zoom in on individual patient care needs and zoom out to the
community and population level to identify and treat the social
determinants of health. Preventive medicine physicians have the
training and expertise to advance the population health outcomes that
public and private payers are increasingly promoting to their
providers. These physicians have a strong focus on quality care
improvement and are at the forefront of efforts to integrate primary
care and public health.
According to the Health Resources and Services Administration
(HRSA) and health workforce experts, there are personnel shortages in
many public health occupations, including epidemiologists,
biostatisticians, and environmental health workers among others.
According to the 2012 Physician Specialty Data Book released by the
Association of American Medical Colleges, preventive medicine had one
of the biggest decrease (-25 percent) in the number of first-year ACGME
residents and fellows between 2005 and 2010. ACPM is deeply concerned
about the shortage of preventive medicine-trained physicians and the
ominous trend of even fewer training opportunities. This deficiency in
physicians trained to carry out core public health activities will lead
to major gaps in the expertise needed to deliver clinical prevention
and community public health. The impact on the health of those
populations served by HRSA may be profound.
Despite being recognized as an underdeveloped national resource and
in shortage for many years, physicians training in the specialty of
Preventive Medicine are the only medical residents whose graduate
medical education (GME) costs are not supported by Medicare, Medicaid
or other third party insurers. Training occurs outside hospital-based
settings and therefore is not financed by GME payments to hospitals.
Both training programs and residency graduates are rapidly declining at
a time of unprecedented national, State, and community need for
properly trained physicians in public health and disaster preparedness,
prevention-oriented practices, quality improvement, and patient safety.
Currently, residency programs scramble to patch together funding
packages for their residents. Limited stipend support has made it
difficult for programs to attract and retain high-quality applicants.
Support for faculty and tuition has been almost non-existent. Directors
of residency programs note that they receive many inquiries about and
applications for training in preventive medicine; however, training
slots often are not available for those highly qualified physicians who
are not directly sponsored by an outside agency or who do not have
specific interests in areas for which limited stipends are available
(such as research in cancer prevention).
HRSA--as authorized in Title VII of the Public Health Service Act--
is a critical funding source for several preventive medicine residency
programs, as it represents the largest Federal funding source for these
programs. HRSA funding ($3.8 million in fiscal year 2014) currently
supports only 55 preventive medicine residents across 8 residency
training programs. An increase of roughly $6 million will allow HRSA to
support nearly 120 new preventive medicine residents.
Of note, the preventive medicine residency programs directly
support the mission of the HRSA health professions programs by
facilitating practice in underserved communities and promoting training
opportunities for underrepresented minorities:
--Thirty-five percent of HRSA-supported preventive medicine graduates
practice in medically underserved communities, a rate of almost
3.5 times the average for all health professionals. These
physicians are meeting a critical need in these underserved
communities.
--Nearly one in five preventive medicine residents funded through
HRSA programs are under-represented minorities, which is almost
twice the average of minority representation among all health
professionals.
--Fourteen percent of all preventive medicine residents are under-
represented minorities, the largest proportion of any medical
specialty.
In addition to training under-represented minorities and generating
physicians who work in medically underserved areas, preventive medicine
residency programs equip our society with health professionals and
public health leaders who possess the tools and skills needed in the
fight against the chronic disease epidemic that is threatening the
future of our Nation's health and prosperity. Correcting the root
causes of this critical problem of chronic diseases will require a
multidisciplinary approach that addresses issues of access to
healthcare; social and environmental influences; and behavioral
choices. ACPM applauds the initiation of programs such as the Community
Transformation Grant that take this broad view of the determinants of
chronic disease. However, any efforts to strengthen the public health
infrastructure and transform our communities into places that encourage
healthy choices must include measures to strengthen the existing
training programs that help produce public health leaders.
Many of the leaders of our Nation's local and State health
departments are trained in preventive medicine. Their unique
combination of expertise in both medical knowledge and public health
makes them ideal choices to head the fight against chronic disease as
well as other threats to our Nation's health. Their contributions are
invaluable. Investing in the residency programs that provide physicians
with the training and skills to take on these leadership positions is
an essential part of keeping Americans healthy and productive. As such,
the American College of Preventive Medicine urges the Labor, Health and
Human Services, Education, and Related Agencies Appropriations
Subcommittee to reaffirm its support for training preventive medicine
physicians and other public health professionals by providing $10
million in fiscal year 2015 for preventive medicine residency training
under the public health and preventive medicine line item in Title VII
of the Public Health Service Act.
______
Prepared Statement of the American College of Radiology
The American College of Radiology (ACR)--a professional
organization serving more than 35,000 radiologists, radiation
oncologists, interventional radiologists, nuclear medicine physicians,
and medical physicists--recommends increased funding for the National
Institutes of Health (NIH) in fiscal year 2015 appropriations
legislation. Specifically, the ACR endorses the position of the Ad Hoc
Group for Medical Research--a coalition of more than 300 patient and
voluntary health groups, medical and scientific societies, academic and
research organizations, and industry--that NIH receive at least $32
billion in fiscal year 2015 as the next step toward a multi-year
increase in our Nation's investment in medical research. That
recommended funding level is approximately $1.874 billion above the
President's Budget request for fiscal year 2015. Additionally, the ACR
joins the Ad Hoc Group in urging Congress and the Administration to
work in a bipartisan manner to end sequestration and the continued cuts
to medical research that squander invaluable scientific opportunities,
discourage young scientists, jeopardize our economic future, and
threaten medical progress and continued improvements in our Nation's
health.
The value of the NIH to American taxpayers is immeasurable, and
there have been several recent examples of impactful science in the
biomedical imaging domain that would not have been realized and
translated swiftly into patient care without NIH support and
involvement. For instance, the NIH National Cancer Institute's (NCI)
nearly decade-long National Lung Screening Trial--conducted by the
American College of Radiology Imaging Network (ACRIN) and Lung
Screening Study group--found that computed tomography (CT) screening of
high risk patients could reduce deaths from lung cancer by 20 percent
versus chest X-ray screening. Another NCI-supported success, the
National CT Colonography Trial--also conducted by ACRIN--found that
virtual colonoscopy was effective as a screening method for colorectal
cancer thanks to its accuracy, safety, cost-effectiveness, and patient
acceptability compared to more invasive and potentially intimidating
screening options. The Radiation Therapy Oncology Group (RTOG) now a
member of the NRG Oncology Group in the new National Clinical Trials
Network (NCTN), is the international leader in investigating the
appropriateness of advanced technologies such as proton therapy and
intensity modulated radiation therapy (IMRT) in multi-center randomized
trials examining the safety, effectiveness, and quality of life
implications of these treatments. Additional ACRIN (now ECOG-ACRIN in
the NCTN) and NRG activities under NCI's purview promise to advance the
areas of personalized early cancer detection, identify biomarkers to
predict treatment effectiveness, reduce the rate of false-positive
imaging examinations, and improve cancer screening outcomes. However,
NCI's funding of cooperative groups in the evolved National Clinical
Trials Network (NCTN) has been severely cut and the groups' planned
budgets are considerably below expectations. We urge Congress to
restore the full funding approved by the NCI's Board of Scientific
Advisors for the organizations that transitioned from the cooperative
group program into the new NCTN.
Although smaller than NCI, the NIH National Institute of Biomedical
Imaging and Bioengineering (NIBIB) has likewise been successful in
advancing the science behind evolving biomedical imaging technologies
and techniques. The ACR played a key role in NIBIB's creation through
co-founding a coalition of likeminded organizations and working with
Federal policymakers to successfully advance the establishing
legislation in 2000. Since its inception, NIBIB has been particularly
effective in supporting training initiatives, educational symposia, and
international collaborations, as well as fostering future generations
of biomedical imaging and bioengineering scientists via innovative
initiatives and communications.
Without significantly increased funding levels for NIH in fiscal
year 2015 and beyond, America's leadership in biomedical research will
decline, scientists will be increasingly discouraged by the lack of
funding opportunities, and innovative technologies and techniques (such
as those supported through NCI and NIBIB) will not be appropriately
researched and translated into patient care. Therefore, the ACR
endorses the Ad Hoc Group for Medical Research's recommendation that
NIH receive at least $32 billion in fiscal year 2015 as part of a
multi-year increase, and that Congress and the Administration work
together to decisively end sequestration.
Thank you for your consideration.
[This statement was submitted by Gloria R. Romanelli, JD, Senior
Director of Legislative and Regulatory Relations, and Michael Peters,
Director of Legislative and Regulatory Affairs.]
______
Prepared Statement of the American Dental Education Association
The American Dental Education Association (ADEA), on behalf of all
65 U.S. dental schools, 700 dental residency training programs, nearly
600 allied dental programs, as well as more than 12,000 faculty who
educate and train the nearly 50,000 students and residents attending
these institutions, submits this statement for the record and for your
consideration as you begin to prioritize fiscal year 2015 appropriation
requests. ADEA urges you to protect the funding and fundamental
structure of Federal programs that provide access to oral healthcare to
millions of American, train the next generation of healthcare providers
and fund cutting-edge dental and craniofacial research.
At ADEA's academic dental institutions, future practitioners and
researchers are trained and significant dental safety-net care is
provided. Services are provided through campus and offsite dental
clinics where students and faculty provide oral healthcare to the
uninsured and underserved populations. And, in light of the findings
that good oral health is inextricably linked to good systemic health,
the need to provide access to oral healthcare is critical. However, in
order to provide these services, there must be adequate funding.
We are asking the committee to help ADEA's member institutions
continue to provide care to all segments of the population by
maintaining adequate funding for programs focused on access to oral
healthcare, dental and craniofacial research, and training for oral
healthcare providers. Specifically we request that you maintain and
protect funding for Title VII of the Public Health Service Act; the
National Institutes of Health (NIH) and the National Institute of
Dental and Craniofacial Research (NIDCR); the Dental Health Improvement
Act; Part F of the Ryan White HIV/AIDS Treatment and Modernization Act:
the Dental Reimbursement Program and the Community-Based Dental
Partnerships Program; and State-Based Oral Health Programs at the
Centers for Disease Control and Prevention (CDC). These programs
enhance and sustain State oral health departments, fund public health
programs proven to prevent oral disease, fund research to eradicate
dental disease and detect certain cancers, and fund programs to develop
an adequate workforce of dentists with advanced training to serve
American citizens including the underserved, the elderly, and those
suffering from chronic immune-compromised conditions and life-
threatening diseases.
We respectfully make the following requests:
--$32 million for Oral Health Training Programs
The dental programs in Title VII, Section 748 of the Public Health
Service Act that provide training in general, pediatric, and public
health dentistry and dental hygiene are critical. Support for these
programs will help to ensure there will be an adequate oral healthcare
workforce. The funding supports pre-doctoral oral health education and
postdoctoral pediatric, general, and public health dentistry training.
The investment that Title VII makes not only helps to educate dentists
and dental hygienists, but also expands access to care for underserved
communities.
Additionally, Section 748 addresses the shortage of professors in
dental schools with the dental faculty loan repayment program and
faculty development courses for those who teach pediatric, general, or
public health dentistry or dental hygiene. There are currently almost
200 open budgeted faculty positions in dental schools. These two
programs provide schools with assistance in recruiting and retaining
faculty. ADEA is increasingly concerned that with projected restrained
funding, the oral health research community will not be able to grow
and that the pipeline of new researchers will be inadequate to the
future need.
Title VII Diversity and Student Aid programs play a critical role
in helping to diversify the health profession's student body and
thereby the healthcare workforce. For the last several years, these
programs have not received adequate funding to sustain the progress
that is necessary to meet the challenges of an increasingly diverse
U.S. population. ADEA is most concerned that the Administration did not
request any funds for the Health Careers Opportunity Program (HCOP).
This program provides a vital source of support for oral health
professionals serving underserved and disadvantaged patients by
providing a pipeline for such individuals from these populations to
learn about careers in healthcare generally and dentistry specifically
that is not available through other workforce programs.
For example, a collaboration between the University of
Connecticut's Schools of Dental Medicine and Medicine have used HCOP
grants to perform extensive outreach to colleges and Historically Black
Colleges and Universities (HBCU); support 30 week and 6 week summer
science enrichment programs in middle schools; support several high
school programs, including a Bridge to the Future Science Mentoring,
support mini dental and medical programs, and in support of a Junior
and Senior Doctors' Academy program. And at the college level the two
schools continue the Bridge to the Future Science Mentor program and
conduct a 7 week Health Disparities Clinical Summer Research Fellowship
program that explores an introduction to health disparities, cross
cultural issues, principles of clinical medicine and skills for public
health research and interventions, techniques for work with diverse
populate and interventions, techniques for work with diverse
populations.
UCONN's program is illustrative of programs that dental schools at
the University of Iowa, Kansas University, University of Maryland-
Baltimore, the University of South Alabama, Marquette University, the
University of Michigan, and many others have sponsored. HRSA reports
that the average grant is only $670,000 and reaches over 7,100 students
from underserved and disadvantaged background.
If policy makers are serious about reversing health disparities and
providing opportunity for underrepresented minorities and economically
disadvantaged individuals they will continue this program at current
levels, if not expand it.
Another vital program targeted at enhancing high quality culturally
competent care in community-based interprofessional clinical training
settings is the Area Health Education Centers (AHEC) program. Again the
Administration's has not requested any funds. The infrastructure
development grants and point of service maintenance and expansion
grants ensure that patients from underserved populations receive
quality care in a technologically current setting and that health
professionals receive training in treating such diverse populations.
The reason given by HRSA in not requesting any appropriations for
next fiscal year is short-sighted and counterproductive. HRSA states
that funding priorities is being redirected to programs that directly
increase the number of primary care health professionals. Increasing
the number of providers without the adequate opportunities to treat
underrepresented populations in their communities makes little clinical
or cultural sense. This is the case especially if the policy goals
remain to increase the number coming from those populations and
practicing in rural and underserved areas. Exposure to the rewards and
professional challenges of such care is a powerful enducement to
accomplishing the goal. ADEA encourages the Committee, in the strongest
possible terms, to continue funding the AHEC program.
--$18 million for Part F of the Ryan White HIV/AIDS Treatment and
Modernization Act: Dental Reimbursement Program (DRP) and the
Community-Based Dental Partnerships Program
Patients with compromised immune systems are more prone to oral
infections like periodontal disease and tooth decay. By providing
reimbursement to dental schools and schools of dental hygiene, the
Dental Reimbursement Program (DRP) provides access to quality dental
care for people living with HIV/AIDS while simultaneously providing
educational and training opportunities to dental residents, dental
students, and dental hygiene students who deliver the care. DRP is a
cost-effective Federal/institutional partnership that provides partial
reimbursement to academic dental institutions for costs incurred in
providing dental care to people living with HIV/AIDS. This program, in
fiscal year 2013, only reimbursed dental schools for the unreimbursed
costs at 23 percent of those costs, continuing the shift of the cost
burden to the schools. This path is not sustainable to provide the
necessary care. The increase requested would reimburse barely half of
the dental school's incurred costs of care.
--$425 million for the National Institute of Dental and Craniofacial
Research (NIDCR)
Discoveries stemming from dental research have reduced the burden
of oral diseases, led to better oral health for millions of Americans,
and uncovered important associations between oral and systemic health.
Dental researchers are poised to make breakthroughs that can result in
dramatic progress in medicine and health, such as repairing natural
form and function to faces destroyed by disease, accident, or war
injuries; diagnosing systemic disease from saliva instead of blood
samples (such as HIV, and certain types of cancer); and deciphering the
complex interactions and causes of oral health disparities involving
social, economic, cultural, environmental, racial, ethnic, and
biological factors. Dental research is the underpinning of the
profession of dentistry. With grants from NIDCR, dental researchers in
academic dental institutions have built a base of scientific and
clinical knowledge that has been used to enhance the quality of the
Nation's oral health and overall health.
Also, dental scientists are putting science to work for the benefit
of the healthcare system through translational research, comparative
effectiveness research, health information technology, health research
economics, and further research on health disparities.
--$19 million for the Division of Oral Health at the Centers for
Disease Control and Prevention (CDC)
The CDC Division of Oral Health expands the coverage of effective
prevention programs. The program increases the basic capacity of State
oral health programs to accurately assess the needs of the State,
organize and evaluate prevention programs, develop coalitions, address
oral health in State health plans, and effectively allocate resources
to the programs. This strong public health response is needed to meet
the challenges of oral disease affecting children and vulnerable
populations.
The level of funds available in recent fiscal years are below the
level needed to adequately sustain an appropriately staffed State
dental program, provide a robust surveillance system to monitor and
report disease, and support State efforts with other governmental, non-
profit, and corporate partners. The current path of funding will
continue to have a negative effect upon the overall health and
preparedness of the Nation's States and communities.
Thank you for your consideration of these requests. ADEA looks
forward to working with you to ensure the continuation of congressional
support for these critical programs. Also, please feel free to use ADEA
as a resource on any matter pertaining to academic dentistry under your
purview.
______
Prepared Statement of the American Dental Hygienists' Association
On behalf of the American Dental Hygienists' Association (ADHA),
thank you for the opportunity to submit testimony regarding fiscal year
2015 appropriations. ADHA appreciates the Subcommittee's past support
of programs that seek to improve the oral health of Americans and to
bolster the oral health workforce. Oral health is a part of total
health and authorized oral healthcare programs require appropriations
support in order to increase the accessibility of oral health services,
particularly for the underserved. ADHA urges that the block on funding
for Section 340G-1 of the Public Health Service Act--a much needed
dental workforce demonstration program--be lifted and that $1.25
million be appropriated. Lifting the block on this dental workforce
grants program, officially titled the Alternative Dental Health Care
Providers Demonstration Program, would send an important signal to
States and to HRSA that innovation in dental workforce is a meritorious
undertaking. Importantly, the authorizing language requires that the
grants be conducted in compliance with State law and that they must
increase access to dental healthcare in rural and other underserved
communities. Further, the Institute of Medicine is required to provide
a qualitative and quantitative evaluation of the grants.
Congress recognized the need to improve the oral healthcare
delivery system when it authorized the Alternative Dental Health Care
Provider Demonstration Grants, Section 340G-1 of the Public Health
Service Act. The Alternative Dental Health Care Providers Demonstration
Grants program is a Federal grant program that recognizes the need for
innovations to be made in oral healthcare delivery to bring quality
care to the underserved by pilot testing new models. The authorizing
statute makes clear that pilots must ``increase access to dental care
services in rural and underserved communities'' and comply with State
licensing requirements.
New dental providers are already authorized in Minnesota and are
under consideration in a number of States, including Connecticut,
Kansas, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, and
Washington State. Both the W.K. Kellogg Foundation and the PEW
Charitable Trust Dental Campaign are investing in State efforts to
increase oral healthcare access by adding new types of dental providers
to the dental team. Further, the U.S. Federal Trade Commission
supported dental workforce expansion in December 2013, noting that
``expanding the supply of dental therapists . . . is likely to increase
the output of basic dental services, enhance competition, reduce costs
and expand access to dental care.'' The National Governors
Association's January 2014 issue brief on ``The Role of Dental
Hygienists in Providing Access to Oral Health Care'' found that
``innovative State programs are showing that increased use of dental
hygienists can promote access to oral healthcare, particularly for
underserved populations, including children'' and that ``such access
can reduce the incidence of serious tooth decay and other dental
disease in vulnerable populations.''
The fiscal year 2014 HHS funding bill included language designed to
block funding for this important demonstration program. We seek your
leadership in removing this unjustified prohibition on funding for the
Alternative Dental Health Care Providers Demonstration Grants. Further,
because the authorizing language required HRSA to begin the dental
workforce grant program under Section 340G-1 within 2 years of its 2010
enactment (i.e., by 2012) and to conclude it within 7 years of
enactment (2017), language directing HRSA to move forward with Section
340G-1 grants despite this timeline is needed. ADHA, along with more
than 60 other oral healthcare organizations, advocated for funding of
this important program. Without the appropriate supply, diversity and
distribution of the oral health workforce, the current oral health
access crisis will only be exacerbated. ADHA recommends funding at a
level of $1.25 million for fiscal year 2015 to support these vital
dental workforce demonstration projects.
Additionally, ADHA joins the American Dental Association, the
American Dental Education Association and others in the oral health
community, in recommending $32 million for Title VII Program Grants to
expand and educate the dental workforce; $19 million for oral health
programming at CDC, and funding of $425 million for National Institute
of Dental and Craniofacial Research.
ADHA urges funding of all authorized oral health programs and
describes some of the key oral health programs below:
Title VII Program Grants to Expand and Educate the Dental Workforce--
Fund at a level of $32 million in fiscal year 2015
A number of existing grant programs offered under Title VII support
health professions education programs, students, and faculty. ADHA is
pleased dental hygienists are recognized as primary care providers of
oral health services and are included as eligible to apply for several
of the grants offered under ``General, Pediatric, and Public Health
Dentistry.'' With millions more Americans eligible for dental coverage
in coming years, it is critical that the oral health workforce is
bolstered. Dental and dental hygiene education programs currently
struggle with significant shortages in faculty and there is a dearth of
providers pursuing careers in public health dentistry and pediatric
dentistry. Securing appropriations to expand the Title VII grant
offerings to additional dental hygienists and dentists will provide
much needed support to programs, faculty, and students in the future.
Oral Health Programming within the Centers for Disease Control--Fund at
a level of $19 million in fiscal year 2015
ADHA joins with others in the dental community in urging $19
million for oral health programming within the Centers for Disease
Control. This funding level will enable CDC to continue its vital work
to control and prevent oral disease, including vital work in community
water fluoridation. Federal grants will serve to facilitate improved
oral health leadership at the State level, support the collection and
synthesis of data regarding oral health coverage and access, promote
the integrated delivery of oral health and other medical services,
enable States to be innovative, and promote a data-driven approach to
oral health programming.
National Institute of Dental and Craniofacial Research--Fund at a
level of $425 million in fiscal year 2015
The National Institute of Dental and Craniofacial Research (NIDCR)
cultivates oral health research that has led to a greater understanding
of oral diseases and their treatments and the link between oral health
and overall health. Research spurs innovation and efficiency, both of
which are vital to improving access to oral healthcare services and
improved oral status of Americans in the future. ADHA joins with others
in the oral health community to support NIDCR funding at a level of
$425 million in fiscal year 2015.
ADHA is the largest national organization representing the
professional interests of more than 150,000 licensed dental hygienists
across the country. In order to become licensed as a dental hygienist,
an individual must graduate from one of the Nation's 335 accredited
dental hygiene education programs and successfully complete a national
written and a State or regional clinical examination. Dental hygienists
are primary care providers of oral health services and are licensed in
each of the 50 States. Hygienists are committed to improving the
Nation's oral health, a fundamental part of overall health and general
well-being. In the past decade, the link between oral health and total
health has become more apparent and the significant disparities in
access to oral healthcare services have been well documented. At this
time, when 130 million Americans struggle to obtain the oral healthcare
required to remain healthy, Congress has a great opportunity to support
oral health prevention, infrastructure and workforce efforts that will
make care more accessible and cost-effective.
Conclusion
ADHA appreciates the difficult task appropriators face in
prioritizing and funding the many meritorious programs and grants
offered by the Federal Government. ADHA urges the Committee to lift the
block on funding for Section 340G-1 of the PHSA, dental workforce
demonstration grants. Lifting the block on funding for these dental
workforce grants would be an important signal to States and to
healthcare stakeholders that exploring new ways of bringing oral health
services to the underserved is a meritorious expenditure of resources.
In addition to the items listed, ADHA also supports full funding for
community health centers, and urges HRSA be directed to further bolster
the delivery of oral health services at community health centers,
including the use of new types of dental providers. ADHA remains a
committed partner in advocating for meaningful oral health programming
that makes efficient use of the existing oral health workforce and
delivers high quality, cost-effective care.
[This statement was submitted by Denise Bowers, RDH, PHD,
President, American Dental Hygienists' Association.]
______
Prepared Statement of the American Foundation for Suicide Prevention
Dear Chairman Harkin and Ranking Moran: As you begin work on the
fiscal year 2015 Labor, Health and Human Services, and Education
Appropriations bill, the American Foundation for Suicide Prevention
(AFSP) respectfully urges you to support investments in public health
research by including $40 million for the National Institute of Mental
Health to conduct suicide prevention and brain research including
studies designed to reduce the risk of self-harm, suicide, and
interpersonal violence; $25 million for the National Violent Death
Reporting System (NVRDS) at the Centers for Disease Control and
Prevention (CDC); $60.15 million for suicide prevention programs under
the Garrett Lee Smith Memorial Act (GLSMA) through the Substance Abuse
Mental Health Services Administration (SAMHSA); and $20 million for the
Mental Health First Aid Program (MHFA).
$40 Million in Funding for Suicide Prevention Research
Suicide, already the 10th leading cause of death overall in the
U.S., the 3rd leading cause of death among 15-24 year olds, and the 2nd
leading cause of death among 24-34 year olds; continues to take more
and more lives each year. In 2010 (latest available data), suicide took
the lives of more than 38,000 Americans, up 31 percent from 2000.
AFSP supports at a minimum a $40 million investment in suicide
prevention research as recommended by Representative Ron Barber in H.R.
4075 (the Suicide Prevention Research Innovation Act or SPRINT Act) so
we can obtain similar reductions in suicide mortality that have
resulted from strategic investments in other major public health
concerns.
Full Funding of $25 Million for the National Violent Death Reporting
System (NVDRS)
The NVDRS collects in-depth information on the details of and
circumstances surrounding each suicide, which goes beyond the basic
information collected through the CDC's National Vital Statistics
Reports/Fatal Injury Report and implementing the NVDRS nationwide is
essential to developing, informing and evaluating suicide prevention
programs.
Currently, the National Violent Death Reporting System collects
surveillance data in only 18 States (Alaska, Colorado, Georgia,
Kentucky, Maryland, Massachusetts, Michigan, New Jersey, New Mexico,
North Carolina, Ohio, Oklahoma, Oregon, Rhode Island, South Carolina,
Utah, Virginia and Wisconsin). The data collected helps inform policy
makers on trends and characteristics of violent deaths within specific
communities so they can design appropriate prevention measures and
evaluate ongoing efforts to curb violence.
Included in the fiscal year 2014 omnibus appropriations bill was an
additional $7.7 million (bringing the program total to $11.2 million)
in funding to expand the program; however, AFSP requests the full $25
million be provided so the CDC would have the resources to scale up
this effort to include all 50 States. Today, there exists no other data
surveillance system that offers this benefit for such a modest
investment. No other data collection or centralization effort carries
the inherent value associated with NVDRS and, in fact, no other effort
has the ability to directly inform and impact State and Federal suicide
prevention activities.
Funding of $60.15 Million for GLSMA Suicide Prevention Programs
Since its creation in 2004, GLSMA has provided resources to
communities and college campuses all across the country, and supported
needed technical assistance to develop and disseminate effective
strategies and promising practices related to youth suicide prevention.
To date, the GLSMA has supported youth suicide prevention grants in 49
States, the District of Columbia and Guam, 48 Tribes or Tribal
organizations, and 138 institutions of higher education.
AFSP requests that the Committee approve $60.15 million for GLSMA
programs in fiscal year 2015 to ensure a continuation of these
critically important youth and college suicide prevention programs.
Funding of $20 Million for Mental Health First Aid (MHFA)
Sometimes, first aid isn't a bandage, or CPR, or the Heimlich, or
calling 911. Sometimes, first aid is you. While many Americans know how
to administer first aid and seek medical help should they come across a
person having a heart attack, few are trained to provide similar help
to someone experiencing a mental health or substance abuse crisis.
Mental Health First Aid is a public education program that helps
people identify, understand, and respond to signs of mental illnesses
and substance abuse. The course teaches participants a 5-step action
plan to reach out to a person in crisis and connect them with
professional, peer, or other help.
AFSP requests that $20 million be approved for MHFA training
programs around the country that would train participants in
recognizing the symptoms of common mental illnesses and addiction
disorders, de-escalating crisis situations safely, and initiating
timely referral to mental health and substance abuse resources
available in the community.
Thank you for your time and consideration of these requests by the
American Foundation for Suicide Prevention. Should you have any
questions I can be reached at jmadigan@afsp.org.
[This statement was submitted by John Madigan, Vice President,
Public Policy.]
______
Prepared Statement of the American Geriatrics Society
Mr. Chairman and Members of the Subcommittee: We submit this
testimony on behalf of the American Geriatrics Society (AGS), a non-
profit organization of over 6,000 geriatrics healthcare professionals
dedicated to improving the health, independence and quality of life of
all older Americans. As the Subcommittee works on its fiscal year 2015
Labor-HHS-Education Appropriations bill, we ask that you prioritize
funding for the geriatrics education and training programs under Title
VII and Title VIII of the Public Health Service Act and for research
funding within the National Institutes of Health/National Institute on
Aging.
We ask that the subcommittee consider the following recommended
funding levels for these programs in fiscal year 2015:
--$39.7 million for Title VII Geriatrics Health Professions Programs
--$5.0 million for Title VIII Comprehensive Geriatric Education
Nursing Program
--An increase of $500 million for aging research within the National
Institutes of Health
While we recognize the fiscal challenges facing our Nation,
sustained and enhanced Federal investments in these initiatives are
essential to delivering higher quality, better coordinated and more
cost effective care to our Nation's seniors. We request that Congress
provide the additional investments necessary to expand and enhance the
geriatrics workforce, which is an integral component of the primary
care workforce, and to foster groundbreaking medical research so that
our Nation is prepared to meet the unique healthcare needs of the
rapidly growing population of seniors.
programs to train geriatrics health care professionals
Our Nation is facing a critical shortage of geriatrics faculty and
healthcare professionals across disciplines. This trend must be
reversed if we are to provide our seniors with the quality care they
need and deserve. Care provided by geriatric healthcare professionals,
who are trained to care for individuals who are the most complex and
frail and who account for 80 percent of our Medicare expenditures, has
been shown to reduce common and costly conditions that are often
preventable with appropriate care, such as falls, polypharmacy, and
delirium.
Title VII Geriatrics Health Professions Programs ($39.7 million)
These programs support three initiatives: the Geriatric Academic
Career Awards (GACAs), the Geriatric Education Center (GEC) program,
and geriatric faculty fellowships. These are the only programs
specifically designed to address the well-documented shortage of
geriatrics healthcare professionals in the U.S. We ask the subcommittee
to provide a fiscal year 2015 appropriation of $39.7 million for Title
VII Geriatrics Health Professions Programs.
Our funding request breaks down as follows:
--Geriatric Academic Career Awards (GACAs) ($5.5 million)
GACAs support the development of newly trained geriatric clinicians
in academic medicine who are committed to teaching geriatrics in
medical schools across the country. GACA recipients are required to
provide training in clinical geriatrics, including the training of
interdisciplinary teams of healthcare professionals. HRSA, through the
Affordable Care Act, expanded the awards to other disciplines--a change
long supported by AGS--and requests adequate funding to reflect this.
In addition, new awardees are only selected every 5 years and we
believe that these awards should be available annually in order to
ensure that we have an adequate number of faculty available to provide
training in the principles of geriatric medicine. Our budget request of
$5.5 million would support GACA program awardees in their development
as clinician educators.
Program Accomplishments.--In Academic Year 2012-2013, the GACA
program funded 62 full-time junior faculty. These awardees delivered
over 1,100 different courses, workshops and other types of training
activities to over 53,000 trainees across the health professions--the
most common of which included medical school students, residents in
internal medicine and residents in geriatrics. In addition, GACA
awardees are highly encouraged to engage in professional development
and scholarly activities during each academic year as a way of
advancing the field of geriatrics. Results showed that the awardees
conducted presentations about their own research and other related
topics at over 215 conferences at the local, State or national level
and published a total of 108 peer-reviewed publications.
--Geriatric Education Centers (GECs) ($20.0 million)
GECs provide grants to support collaborative arrangements involving
several health professions, schools and healthcare facilities to
provide multidisciplinary training in geriatrics, including assessment,
chronic disease syndromes, care planning, emergency preparedness, and
cultural competence unique to older Americans. Our funding request of
$20.0 million includes continued support for the core work of 45 GECs
($20.0).
Program Accomplishments.--In Academic Year 2012-2013, the GECs
supported various types of geriatrics-specific training for health
professions students and faculty, as well as for current community-
based providers--delivering over 1,650 different continuing education
courses to over 94,000 trainees. This exceeded the program's
performance target by 58.5 percent. GEC grantees also partnered with
over 650 healthcare delivery sites across the country to provide
clinical and experiential training, in areas such as nursing homes and
chronic and acute disease hospitals, to over 25,000 trainees. It is
estimated that 2 out of every 5 sites used by GEC grantees for the
purposes of offering these types of training were primary care settings
and/or were located in a medically underserved community.
--Alzheimer 's Disease Prevention, Education, and Outreach
Program.--Funding for this program was included in the
President's fiscal year 2015 budget request and allows HRSA
to expand efforts to provide interprofessional continuing
education to healthcare practitioners on Alzheimer's
disease and related dementias through the already existing
GECs. We are requesting $5.3 million to support this
program.
--Geriatric Training for Physicians, Dentists, Behavioral/Mental
Health Professions ($8.9 million)
This program is designed to train physicians, dentists, and
behavioral and mental health professionals who choose to teach
geriatric medicine, dentistry or psychiatry. The program provides
fellows with exposure to older adult patients in various levels of
wellness and functioning, and from a range of socioeconomic and racial/
ethnic backgrounds. Our funding request of $8.9 million will support
this important faculty development program.
Program Accomplishments.--In Academic Year 2012-2013, a total of 64
physicians, psychiatrists, dentists, and psychologists, were supported
through this program. These fellows received clinical training in over
200 different healthcare delivery sites across the country; the most
common types of sites where fellows trained included Veteran's Affairs
hospitals and clinics, private hospitals, and academic centers. It is
estimated that nearly half of the sites (49 percent) where GTPD fellows
received clinical training were located in a medically underserved
community. Additionally, results showed that GTPD fellows delivered
over 275 courses, workshops and other training activities focused on
topics including oral health, chronic disease management and geriatric
medicine, among others. It is estimated that over 5,600 trainees were
trained as a result of these activities--the most common of which
included medical school students, dental school students, residents in
geriatrics and residents in geriatric psychiatry.
Title VIII Comprehensive Geriatric Education Nursing Program ($5.0
million)
The American healthcare delivery system for older adults will be
further strengthened by Federal investments in Title VIII Nursing
Workforce Development Programs, specifically the comprehensive
geriatric education grants, as nurses provide cost-effective, quality
care. This program supports additional training for nurses who care for
the elderly, development and dissemination of curricula relating to
geriatric care, and training of faculty in geriatrics. It also provides
continuing education for nurses practicing in geriatrics. Our funding
request of $5.0 million includes funds to continue the training of
nurses caring for older Americans.
Program Accomplishments.--In Academic Year 2012-2013, the
Comprehensive Geriatric Education Program (CGEP) supported numerous
types of geriatric-related training programs and activities for health
professions students and their faculty, as well as for community-based
healthcare providers across the country. CGEP grantees offered over 150
different continuing education (CE) courses to over 11,600 trainees
across the health professions. In addition, 74 students received
traineeships--the majority of which (81 percent) are pursuing a Masters
Degree in Nursing to become Nurse Practitioners in the fields of Adult
Gerontology or Acute Care in Adult Gerontology.
Grantees of the CGEP also developed and implemented over 120
different geriatric-focused training activities to include new
continuing education courses for current providers, as well as new
academic courses and clinical rotations for health professions
students, residents and fellows across the country focused on these
issues. It is estimated that a total of 4,500 trainees were reached as
a result of these activities. Lastly, CGEP grantees supported over 40
different faculty development activities and programs. It is estimated
that over 300 faculty-level trainees were trained on emerging issues in
the field of geriatrics (e.g., pain management among the elderly,
advances in patient engagement, among others) as a result of these
activities.
research funding initiatives--national institutes of health/national
institute on aging
The institutes that make up the NIH, and in particular the NIA,
lead a broad scientific effort to understand the nature of aging and to
extend the healthy, active years of life. As a member of the Friends of
the NIA, a broad-based coalition of aging, disease, research, and
patient groups committed to the advancement of medical research that
affects millions of older Americans, AGS urges an increase in NIH
funding of $500 million to support aging research across all
institutes.
Considering what the Federal Government spends on the healthcare
costs associated with age-related diseases, it makes sound economic
sense to increase Federal resources for aging research. Chronic
diseases associated with aging afflict 80 percent of the age 65+
population and account for more than 75 percent of Medicare and other
Federal health expenditures. Continued Federal investments in
scientific research, including comparative effectiveness initiatives,
will ensure that the NIH has the resources to succeed in its mission to
establish research networks, assess clinical interventions and
disseminate credible research findings to patients, providers and
payers of healthcare.
In closing, geriatrics is at a critical juncture, with our Nation
facing an unprecedented increase in the number of older patients with
complex health needs. Strong support such as yours will help ensure
that every older American is able to receive high-quality healthcare.
Thank you for your consideration.
______
Prepared Statement of the American Heart Association
Although great progress has been made in prevention and treatment
of cardiovascular disease, including stroke, there is no cure and CVD
remains America's No. 1 killer, costing a projected $315 billion in
medical expenses and lost productivity each year. Stroke, alone, is our
No. 4 killer, costing an estimated $37 billion a year. Both remain
major causes of disability.
Nearly 84 million U.S. adults suffer from some form of CVD. It is
projected that by the year 2030, more than 44 percent of U.S. adults
will live with CVD at a cost exceeding $1 trillion annually. So, it is
disturbing that CVD research, prevention and treatment remain
disproportionately underfunded with no sustained and stable funding
from the National Institutes of Health. NIH is key for the U.S. to
mount an ongoing and effective crusade against these devastating
diseases.
We appreciate Congress' and the Administration's partial stay of
sequestration. These cuts jeopardize the health of tens of millions of
CVD sufferers and weaken our fragile economy and erode our global
leadership in medical research. We challenge Congress to appropriate
stable and sustained funding for CVD research, prevention and
treatment. NIH funding is not only important for the health of our
Nation, but also supports our economy through research-related
employment opportunities it provides.
funding recommendations: investing in the health of our nation
Research that could move us closer to a cure for heart disease and
stroke goes unfunded. Congress must capitalize on 50 years of progress
or our Nation will pay more in lives lost and healthcare costs. Our
recommendations tackle the topics in a fiscally responsible way.
Capitalize on Investment for the National Institutes of Health (NIH)
AHA is disappointed Congress did not fully restore sequester cuts
for NIH in Public Law 113-76. NIH funded studies help prevent and cure
disease, revolutionize patient care, drive economic growth, advance
innovation, and sustain U.S. leadership in pharmaceuticals and
biotechnology. NIH is the world's leader of basic research--the
starting point for all medical progress and an indispensable Federal
Government role that the private sector cannot fill. The U.S. is in
jeopardy of losing our competitive edge in scientific research.
In addition to improving health, NIH creates a solid return on
investment. In fiscal year 2012, NIH supported 400,000 U.S. jobs and
produced nearly $60 billion in new economic activity. Every $1 in NIH
funding produced $2 in economic activity in 2007. Yet, for the past
decade, the NIH's budget has not kept pace with medical research
inflation, resulting in more than a 20 percent loss in purchasing
power. Such reductions, along with only a 50 percent restoration of
sequester cuts, have occurred during a time of remarkable heightened
scientific opportunity and when other countries have been increasing
investment in science--some by double digits. These cutbacks have also
demoralized early career investigators who, sadly, may leave and never
return to research. We cannot afford to lose one of our Nation's most
valuable resources--an innovative biomedical research workforce.
American Heart Association Advocates: We ask Congress to
appropriate $32 billion for NIH to restore sequester cuts, provide for
modest growth, and advance CVD research.
Enhance Funding for NIH Heart and Stroke Research: A Proven and Wise
Investment
Declining death rates from CVD is directly related to NIH research,
with scientists on the verge of discoveries that could lead to
groundbreaking treatments and even cures. In addition to saving lives,
NIH research is cost-effective. For example, the first NIH tPA drug
trial resulted in a 10-year net $6.47 billion drop reduction in stroke
healthcare costs.
Cardiovascular Disease Research: National Heart, Lung, and Blood
Institute (NHLBI)
CVD death rates have greatly declined, with much of the reduction
traced to research emanating from the NHLBI. Stable and sustained NHLBI
funding is key to capitalize on investments that have led to major
discoveries. For example, 10 percent of genetic changes leading to
severe congenital heart disease are new and not passed down by a
parent; people who maintained ideal health had better brain function in
mid-life; digestive system bacteria may cause red meat to raise two
chemicals linked to CVD; and post-traumatic stress disorder may be a
heart disease risk factor. Sustained funding will allow robust
implementation of priority CVD strategic plan initiatives.
Stroke Research: National Institute of Neurological Disorders and
Stroke (NINDS)
An estimated 795,000 Americans will suffer a stroke this year and
more than 129,000 will die. Many of the 7 million survivors face grave
physical and mental disabilities and emotional trauma. In addition to
the physical and emotional toll, stroke costs an estimated $37 billion
in medical expenses and lost productivity each year. Moreover, the
future looks grim. A study projects that direct costs of stroke will
triple between 2010 and 2030.
Stable and sustained NINDS funding is needed to capitalize on
investments, including one showing aggressive medical treatment is
better than stents in preventing a second stroke, and to advance the
BRAIN Initiative. More resources are required to facilitate the NIH
Stroke Trials Network and other priorities in stroke prevention,
treatment and recovery research. They include: hastening translation of
preclinical animal models into clinical studies; preventing vascular
cognitive damage; expediting comparative effectiveness research trials;
developing imaging biomarkers; refining clot-busting treatments;
achieving robust brain protection; targeting early stroke recovery; and
using neural interface devices.
American Heart Association Advocates: We recommend that NHLBI be
funded at $3.2 billion and NINDS at $1.7 billion for fiscal year 2015.
Increase Funding for the Centers for Disease Control and Prevention
(CDC)
Prevention is the best way to promote good health and reduce the
costs of heart disease and stroke. Yet, proven prevention approaches
are not implemented due to limited funds. We applaud Congress for
providing in Public Law 113-76 the Division for Heart Disease and
Stroke Research with a much needed boost. In addition to supporting
research and evaluation and developing a surveillance system, the DHDSP
administers Sodium Reduction Communities and the Paul Coverdell
National Acute Stroke Registry. DHDSP, with the Centers for Medicare
and Medicaid Services, implements Million HeartsTM to
prevent 1 million heart attacks and strokes by 2017.
DHDSP runs WISEWOMAN, serving uninsured and under-insured, low-
income women ages 40 to 64. It helps them from becoming heart disease
and stroke statistics by offering preventive health services, referrals
to local healthcare, and tailored lifestyle programs to promote lasting
behavioral change.
American Heart Association Advocates: We join with the CDC
Coalition in asking for $7.8 billion for CDC's program level. AHA
requests $130.188 million for the DHDSP to sustain its participation in
the State Public Health Actions to Prevent and Control Diabetes, Heart
Disease, Obesity and Associated Risk Factors and Promote School Health
and $37 million for WISEWOMAN. We ask for $3 million for Million
HeartsTM to better control blood pressure.
Restore Funding for Rural and Community Access to Emergency Devices
(AED) Program
About 90 percent of cardiac arrest victims die outside of a
hospital. Yet, early CPR and use of an automated external defibrillator
can more than double survival. Communities with full AED programs have
survival rates near 40 percent. HRSA's Rural and Community AED Program
awards competitive grants to States to buy AEDs, tactically place them,
and train lay rescuers and first responders in their use. Nearly 800
patients were saved from August 1, 2009 to July 31, 2010. But scarce
resources let only 22 percent of approved applicants in 6 States
receive funds in fiscal year 2013.
American Heart Association Advocates: We ask for a fiscal year 2015
appropriation of $8.927 million to return this life-saving AED program
to fiscal year 2005 levels when 47 States were funded.
conclusion
Cardiovascular disease, including stroke, still wreak a deadly,
disabling and costly toll on Americans. Our recommendations for NIH,
CDC and HRSA will save lives and slash escalating healthcare costs. We
challenge Congress to carefully study our requests that signify a wise
investment for our country and for the health and well-being of this
and future generations.
[This statement was submitted by Mariell Jessup, M.D., President,
American Heart Association.]
______
Prepared Statement of the American Indian Higher Education Consortium
This statement includes the fiscal year 2015 recommendations of the
Nation's Tribal Colleges and Universities (TCUs), in two areas of the
Department of Education: Office of Postsecondary Education and Office
of Vocational Education.
higher education act programs
Strengthening Developing Institutions.--Titles III and V of the
Higher Education Act support institutions that enroll large proportions
of financially disadvantaged students and have low per-student
expenditures. The TCUs, which by any definition are truly developing
institutions, funded under Title III-A Sec. 316 are providing quality
higher education opportunities to some of the most rural/isolated,
impoverished, and historically underserved areas of the country. The
goal of HEA-Titles III/V programs is ``to improve the academic quality,
institutional management and fiscal stability of eligible institutions,
in order to increase their self-sufficiency and strengthen their
capacity to make a substantial contribution to the higher education
resources of the Nation.'' The TCU Title III-A program is specifically
designed to address the critical, unmet needs of their American Indian
students and communities, in order to effectively prepare them to
succeed in a globally competitive workforce. Yet, in fiscal year 2011
this critical program was cut by over 11 percent, by another 4 percent
in fiscal year 2012, and hit by sequestration--on the lowered
baseline--in fiscal year 2013. Although sequestration was not imposed
in fiscal year 2014, the TCUs have not recovered from the earlier cuts
to this vitally important program. The TCUs urge the Subcommittee to
restore the discretionary funding for HEA Title III-A, Sec. 316 to
$30,000,000 in fiscal year 2015.
TRIO.--Retention and support services are vital to achieving the
national goal of having the highest proportion of college graduates in
the world by 2020. TRIO programs, such as Student Support Services and
Upward Bound, were created out of recognition that college access is
not enough to ensure advancement and that multiple factors work to
prevent the successful completion of postsecondary programs for many
low-income and first-generation students and students with
disabilities. Therefore, in addition to providing the maximum Pell
Grant award level, it is critical that Congress also sustain student
assistance programs, such as Student Support Services and Upward Bound
so that low-income and minority students have the Federal support
necessary to allow them to remain enrolled in and ultimately complete
their higher education degrees.
Pell Grants.--The importance of Pell Grants to TCU students cannot
be overstated. Approximately, 80 percent of TCU students receive Pell
Grants, primarily because student income levels are so low and they
have far less access to other sources of financial aid than students at
State-funded and other mainstream institutions. Within the TCU system,
Pell Grants are doing exactly what they were intended to do--they are
serving the needs of the lowest income students by helping them gain
access to quality higher education, an essential step toward becoming
active, productive members of the workforce. However, the U.S.
Department of Education has changed its regulations to limit Pell
eligibility from 18 to 12 full-time semesters, without any
consideration of those already in the process of earning a
postsecondary degree. This change in policy has impeded some TCU
students from completing a postsecondary degree, which is widely
recognized as being critical for access to, and advancement in, today's
highly technical workforce.
TCUs are open enrollment institutions. Recent placement tests
administered at TCUs to first-time entering students indicated that 74
percent required remedial math, 54 percent required remedial reading,
and 57 percent needed remedial writing. These results clearly
illustrate just how serious this new Pell Grant eligibility limit is to
the success of TCU students in completing a postsecondary degree.
Students requiring remediation can use as much as a full year of
eligibility enhancing their math, and or reading/writing skills,
thereby hampering their future postsecondary degree plans. A prior
national goal was to provide access to quality higher education
opportunities for all students regardless of economic means, at which
TCUs have been extremely successful. While the new national goal
intends to produce graduates with postsecondary degrees by 2020, this
change in policy does not advance that objective. On the contrary, the
new regulations will cause many low-income students to once again
abandon their dream of a postsecondary degree, as they will simply not
have the means to continue to pursue it. The goal of a well-trained
technically savvy workforce will be greatly compromised. This new
policy evokes the adage ``penny wise--pound foolish.'' The TCUs urge
the Subcommittee to continue to fund this essential program at the
highest possible level, and to direct the Secretary of Education to
implement a process to waive the very restrictive 12 semester Pell
Grant eligibility for TCU students.
perkins career and technical education programs
Tribally-Controlled Postsecondary Career and Technical
Institutions.--Section 117 of the Carl D. Perkins Career and Technical
Education Act provides a competitively awarded grant opportunity for
tribally chartered and controlled career and technical institutions.
AIHEC requests $8,200,000 to fund grants under Sec. 117 of the Perkins
Act.
Native American Career and Technical Education Program (NACTEP).--
NACTEP (Sec. 116) reserves 1.25 percent of appropriated funding to
support American Indian career and technical programs. The TCUs
strongly urge the Subcommittee to continue to support NACTEP, which is
vital to the continuation of career and technical education programs
offered at TCUs that provide job training and certifications to remote
reservation communities.
american indian adult and basic education (office of vocational and
adult education)
This program supports adult basic education programs for American
Indians offered by State and local education agencies, Indian tribes,
agencies, and TCUs. Despite the absence of dedicated funding, TCUs must
find a way, often using already insufficient institutional operating
funds, to continue to provide adult basic education classes for those
American Indians that the present K-12 Indian education system has
failed. Before many individuals can even begin the course work needed
to learn a productive skill, they first must earn a GED or, in some
cases, even learn to read. The new GED exam, which was instituted in
January 2014, has a much stronger focus on mathematics. As noted
earlier, placement tests for TCU entering students reveal a tremendous
need for math remediation. Additionally, the new GED test is fully
computerized. While younger GED seekers may be well versed and
comfortable with computer-based testing, older and poorer citizens may
not be. These factors indicate a further and growing need for adult
basic educational programs and GED preparation on Indian reservations.
TCUs must have sufficient and stable funding to continue to provide
these essential activities and to ensure their communities residents
have the same chances to succeed as others throughout the country have.
TCUs request that the Subcommittee direct that $8,000,000 of the funds
appropriated annually for the Adult Education State Grants be made
available to make competitive awards to TCUs to help meet the growing
demand for adult basic education and remediation program services on
their respective Reservations.
further justifications for fiscal year 2015 appropriations requests for
tcus
Tribal colleges and our students are already being
disproportionately impacted by ongoing efforts to reduce the Federal
budget deficit and control Federal spending. The fiscal year 2011
Continuing Resolution eliminated all of the Department of Housing and
Urban Development's Minority Serving Institutions (MSIs) community-
based programs, including a critically needed TCU-HUD facilities
program. TCUs were able to maximize leveraging potential, often
securing even greater non-Federal funding to construct and equip Head
Start and early childhood centers; student and community computer
laboratories and public libraries; and student and faculty housing in
rural and remote communities where few and sometimes none of these
facilities existed. Important STEM programs, administered by the
National Science Foundation and NASA were cut, and for the first time
since the NSF program was established in fiscal year 2001, no new TCU-
STEM awards were made in fiscal year 2011. While NSF-TCUP grants
resumed in fiscal year 2012, a year of grant opportunity was lost. TCUs
Additionally, TCUs and their students suffer the realities of cuts to
programs such as GEAR-UP, TRIO, SEOG, and as noted earlier, are
seriously impacted by the new highly restrictive Pell Grant eligibility
criteria more profoundly than mainstream institutions of higher
education, which can realize economies of scale due to large
endowments, alternative funding sources, including the ability to
charge higher tuition rates and enroll more financially stable
students, and access to affluent alumni. The loss of opportunities that
cuts to DoEd, HUD, NSF, and NASA programs represent to TCUs, and to
other MSIs, is magnified by cuts to workforce development programs
within the Department of Labor, nursing and allied health professions
tuition forgiveness and scholarship programs operated by the Department
of Health and Human Services, and an important TCU-based nutrition
education program planned by USDA. Combined, these cuts strike at the
most economically disadvantaged and health-challenged Americans.
We respectfully request that the Members of the Subcommittee
continue the Federal investment in the Nation's Tribal Colleges and
Universities and full consideration of our fiscal year 2015
appropriations needs and recommendations.
______
Prepared Statement of the American Physiological Society
The American Physiological Society (APS) thanks the subcommittee
for its ongoing support of the National Institutes of Health (NIH).
Research carried out by the NIH contributes to our understanding of
health and disease, which allows all Americans to look forward to a
healthier future. The APS urges you to make every effort to provide the
NIH with a net funding level of $32 billion in fiscal year 2015. This
is necessary to prevent further erosion of research capacity.
Federal investment in research is critically important because
breakthroughs in basic and translational research are the foundation
for new drugs and therapies that help patients, fuel our economy, and
provide jobs. The Federal Government is the primary funding source for
discovery research through competitive grants awarded by the NIH.
Although the private sector partners with academic researchers to
develop research findings into new treatments, industry relies upon
federally funded research to identify where innovation opportunities
can be found. This system of public-private partnership has been
critical to U.S. leadership in the biomedical sciences. However, this
position of leadership is at risk as other nations, including China,
increase their investments in research and development while the United
States investment has lagged in recent years.
Federal research dollars also have a significant impact at the
local level: Approximately 85 percent of the NIH budget is awarded
throughout the country to researchers who use grant funds to pay
research and administrative staff, purchase supplies and equipment, and
cover other costs associated with their research.
NIH funds outstanding science
As a result of improved healthcare, Americans in the 21st century
are living longer and healthier lives than ever before. However,
chronic conditions such as cardiovascular disease, diabetes,
respiratory illnesses, Alzheimer's and cancer continue to inflict a
heavy burden in the United States and around the world. As the U.S.
population ages, the prevalence and cost of these diseases will
increase exponentially. The NIH invests heavily in basic research to
understand the physiological mechanisms at work in health and disease.
This knowledge is crucial to the development of safe and effective
interventions and prevention strategies.
Exciting new initiatives are underway at the NIH to advance
science, including the Brain Research through Advancing Innovative
Neurotechnologies (``BRAIN'') initiative and the Big Data 2 Knowledge
project (BD2K). The BRAIN initiative will bring together researchers
from diverse disciplines to tackle major gaps in current knowledge
about the brain and brain diseases. BD2K will explore ways to
capitalize on the immense volume of data being created by biomedical
scientists, ultimately enhancing the work of the entire community by
providing new tools and resources to make better use of that data.
These important projects require significant resources, and at a time
of constrained budgets, that will further diminish funding for
investigator-initiated grants. The NIH system of allowing investigators
to develop and propose ideas which are then evaluated by their peers
and selected for funding based on their merit has fostered a research
enterprise that is second to none. Increasing the NIH budget to $32
billion would provide funding for large projects as described above,
while also providing resources for individual scientists to pursue
creative new avenues of research.
NIH nurtures the biomedical research enterprise
In addition to supporting research, the NIH must also address
workforce issues to ensure that our Nation's researchers are ready to
meet the challenges they will face in the future. The pressures placed
on the biomedical research enterprise after years of sub-inflationary
budget increases were severely compounded by sequestration cuts in
fiscal year 2013. One analysis showed that NIH supported approximately
1000 fewer investigators in fiscal year 2013 as a result of its
declining budget.\1\ Researchers who lose their funding face an
uncertain future as there are few options to sustain their research
without Federal grants. Losing Federal support puts at risk the
investment that it took to build those programs over many years. It
also means that talented individuals working in those labs will have to
look elsewhere for increasingly scarce jobs. As a result of stagnant
funding for NIH, scientists at all stages of their careers struggle to
maintain their research programs.
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Scientists in the early stages of their careers face a particular
set of challenges as they work to establish themselves during a time of
dwindling resources. To address some of these problems, the NIH is
continuing its commitment to fund new investigators at approximately
the same rate as established investigators. The NIH is also developing
three new efforts to ensure a diverse and sustainable future biomedical
workforce. The National Research Mentoring Network (NRMN) and the
Building Infrastructure Leading to Diversity (BUILD) initiative are
complementary programs that will develop innovative new mentorship
programs to engage individuals from diverse backgrounds and help them
prepare to succeed in biomedical research careers. The Coordination and
Evaluation Center (CEC) will play a role in coordinating and assessing
NRMN and BUILD, providing program-wide goals and tools to assess
progress. These efforts are critical to helping young scientists launch
their careers. However, to sustain a talented workforce the NIH needs
predictable and sustainable budget growth. If the current funding
crisis is not resolved, the continued loss of senior researchers will
begin to erode the pool of experienced mentors for early career
scientists on which the BUILD and NRMN programs rely.
The NIH also uses the Institutional Development Award (IDeA)
Program to broaden the geographic distribution of NIH funds by
providing support to researchers and institutions in areas that have
not previously received significant NIH funding. IDeA builds research
capacity and improves competitiveness in those States by developing
shared resources, infrastructure and expertise. Networks established
through this program expand research opportunities for students and
faculty at predominantly undergraduate institutions and enhance the
level of science and technology knowledge of the workforce in IDeA
States. The program currently serves institutions and researchers in 23
States and Puerto Rico. The APS believes this program is an important
way to broaden participation in the scientific workforce.
The APS appreciates the support of the committee in continuing the
Science Education Partnership Awards (SEPA) program at the NIH. This
program was slated for elimination last year under the proposed
consolidation of science education programs across Federal agencies.
The SEPA program fosters important connections between biomedical
researchers and K-12 students and teachers, providing an opportunity
for students at the earliest levels to learn about STEM careers. No
other Federal STEM program addresses biomedicine or provides this kind
of outreach concerning what NIH does to promote the health of our
citizens. Thus, SEPA programs promote health literacy among young
individuals, who will increasingly be expected to manage their own
healthcare. Many of the programs sponsored by SEPA, including those at
the APS, disproportionately reach underrepresented and disadvantaged
students. The APS believes that the SEPA program helps establish the
groundwork to address issues of workforce diversity and health
literacy.
The APS is a professional society dedicated to fostering research
and education as well as the dissemination of scientific knowledge
concerning how the organs and systems of the body work. The Society was
founded in 1887 and now has more than 10,000 member physiologists. APS
members conduct NIH-supported research at colleges, universities,
medical schools, and other public and private research institutions
across the U.S.
The APS joins the Federation of American Societies for Experimental
Biology (FASEB) in urging that NIH be provided with no less than $32
billion in fiscal year 2014.\2\
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[This statement was submitted by Kim E. Barrett, Ph.D., President,
American Physiological Society.]
______
Prepared Statement of the American Psychological Association
The American Psychological Association (APA) is the largest
scientific and professional organization representing psychology in the
U.S.: its membership includes nearly 130,000 researchers, educators,
clinicians, consultants and students. APA works to advance the
creation, communication and application of psychological knowledge to
benefit society and improve people's lives. Many programs in the Labor-
HHS-Education bill impact science, education, and the populations
served by clinical psychologists.
National Institutes of Health.--The Consolidated Appropriations Act
of 2014 increase for NIH did not give back all of the funds cut by
sequestration in fiscal year 2013 nor did it restore the purchasing
power lost over the past decade. As a member of the Ad Hoc Group for
Medical Research, APA recommends that NIH receive at least $32 billion
in fiscal year 2015 as the next step toward a multi-year increase in
our Nation's investment in health research. APA also urges Congress and
the Administration to work in a bipartisan manner to end sequestration
and the continued cuts to health research that squander invaluable
scientific opportunities, discourage young scientists, threaten or slow
improvements in our Nation's health, and jeopardize our economic
future.
Psychological scientists are supported by research grants or
training programs in almost all of NIH's 27 institutes and centers.
They are working with animal models or human participants to improve
diagnosis and treatment of Alzheimer's disease and autism, to
understand the mechanisms underlying adoption of healthy behaviors, and
to help prevent transmission of HIV and unhealthy behaviors such as
substance abuse. Behavioral research is critical to NIH's mission:
approximately 40 percent of premature mortality in the U.S. is due to
behaviors such as smoking, sedentary lifestyle, and alcohol and other
drug consumption. APA encourages continued support for OppNet, the
trans-institute initiative funded through the Office of Behavioral and
Social Sciences Research that has led to some $90 million in funding of
basic research through fiscal year 2013 on critical issues such as
sleep, stress, and multisensory perception. As NICHD develops
initiatives to understand and prevent harmful and costly preterm
births, APA encourages that institute to enhance research on
psychological factors that may contribute.
There remains a disturbing paucity of scientific evidence about the
effects of sporadic vs. regular use of marijuana, alcohol, nicotine and
other substances on the developing brain. A large-scale, prospective
study that (a) includes brain imaging and (b) begins in late childhood
(prior to substance exposure) and continues into early adulthood is
urgently needed. Now is the time to begin an in-depth and definitive
longitudinal study to document the short- and long-term effects of
substance use and, in particular, the impact on young brains to inform
future drug policy decisions. By tracking brain development and various
life outcomes alongside behavioral data on substance use, the study
would also illuminate the developmental effects of individual
substances as well as substance interactions, as well as better
establish the relationship between substance use and other mental
disorders (e.g., does substance use predispose adolescent users to
mental illness; do subclinical or premorbid symptoms of mental illness
lead to substance use; or are associations due to a shared
vulnerability?). APA urges the NIH to conduct such a study as part of
the Collaborative Research on Addictions at NIH (CRAN initiative) to
comprehensively document the biological and behavioral effects of
substance use on the developing brain by conducting a longitudinal
naturalistic study monitoring a nationally representative sample of
10,000 healthy 10-year-old children over the course of 10 years.
Centers for Disease Control and Prevention.--As a member of the CDC
Coalition, APA supports at least $7.8 billion for core programs in
fiscal year 2015. Rather than relying on the Prevention Fund and other
transfers, APA urges the committee to restore CDC's budget authority.
As a member of the Friends of NCHS, APA recommends a program level of
$182 million for the National Center on Health Statistics. APA strongly
supports the President's request for increased funding for the National
Injury Prevention and Control Center, including $10 million research
into the causes and prevention of gun violence, to allow the CDC to
carry out the critical research agenda developed last year by the
Institute of Medicine and the National Research Council, and for $23.57
million for the National Violent Death Reporting System, to allow for
its expansion to all 50 States and DC. APA is pleased that the
Committee provided an increase in funding for the Prevention Research
Centers program in fiscal year 2014, and urges that funding be restored
for the program to at least $28 million in fiscal year 2015, consistent
with the fiscal year 2011 funding level, to support research essential
to the focus on prevention. APA supports the President's request of
$360.7 million for surveillance, research and programs to support HIV
prevention in the Division of HIV/AIDS Prevention, an increase of $4.3
million above fiscal year 2014. Additional resources should be directed
toward behavioral and social science research that optimizes outcomes
along the HIV care continuum; implementation science to enhance linkage
and retention in care; research on adherence to treatment; developing
and scaling up interventions for most the impacted persons living with
HIV/AIDS; development, adaptation and implementation of innovative
strategies to address stigma and discrimination; and research into
structural and environmental factors that drive the HIV epidemic.
Substance Abuse and Mental Health Services Administration.--APA
strongly supports:
--The National Child Traumatic Stress Network (NCTSN) program. APA
recommends increased support for the Network's efforts on
behalf of the recovery of children, families, and communities
affected by physical and sexual abuse, school and community
violence, natural disasters, sudden death of a loved one, war's
impact on military families, and other trauma.
--Garrett Lee Smith Memorial Act programs--Campus Suicide Prevention,
State and Tribal Youth Suicide Prevention and the Suicide
Prevention Resource Center. These effective national programs
help meet the mental and behavioral health needs of youth and
young adults through access to prevention, education, and
outreach services to reduce suicide risk in these populations.
First authorized in 2004, the Garrett Lee Smith Memorial Act
has supported youth suicide prevention grants in 49 States, 48
Tribes or Tribal organizations, and 138 institutions of higher
education.
--Minority Fellowship Program. APA remains concerned that while
minorities represent 30 percent of the population and are
projected to increase to 40 percent by 2025, only 23 percent of
recent doctorates in psychology, social work and nursing were
awarded to minorities. We encourage the Committee to support
the Administration's $5 million increase for the MFP as
requested in the fiscal year 2015 budget proposal. The increase
reflects the need to continually grow the pool of culturally
competent mental health professionals.
--Mental Health Care Provider Education in HIV/AIDS Program, in CMHS.
Continuing education for mental health providers in these
crucial clinical issues remains a high priority. APA urges
Congress to maintain level funding in CMHS for the training of
psychologists, social workers, and psychiatrists in mental
health and psychosocial issues related to HIV/AIDS.
--SAMHSA-funded programs providing vital substance abuse and mental
health services to people with HIV/AIDS.
--SAMHSA's Safe Schools/Healthy Students program that expands access
to mental and behavioral health services in schools and reduces
violence through prevention and early intervention supports.
Health Resources and Services Administration.--APA recommends
funding SSA Section 512 regarding services to individuals with a
postpartum condition. Postpartum Depression (PPD) is one of the most
common and frequently undiagnosed conditions associated with
childbirth. In the U.S. approximately one in five women suffers from
PPD each year. While PPD is a widespread problem, under the current
USPSTF guidelines, depression screening is available as an Essential
Health Benefit to all non-pregnant adults, yet excludes the vulnerable
population of pregnant women. APA supports funding for this as-yet
unfunded provision that supports PPD research and treatment and the
incorporation of screening and linkages to behavioral health treatment
for families affected by this condition. APA encourages the Committee
to support incorporation of PPD screening into the Title V programs
administered by HRSA as well as Healthy Start. APA also encourages the
Committee to urge the Secretary to prioritize the issue of PPD by
raising awareness, expanding research, and establishing grants for the
operation and coordination of cost-effective services to afflicted
women and their families.
APA recommends continued investments in the mental and behavioral
health workforce, including $6.9 million for the Graduate Psychology
Education program to increase the number of health service
psychologists trained to provide services to high-need and high-demand
underserved populations in both urban and rural communities. This
program supports the training of doctoral psychology students, interns
and postdoctoral residents with other health professionals while they
provide supervised mental and behavioral health services to underserved
and vulnerable populations, including: children, older adults, veterans
and their families, individuals with chronic illnesses, and victims of
abuse and trauma. In 2010-2011 alone, the GPE program supported the
training of 620 graduate psychology students and provided mental and
behavioral health services to over 46,000 underserved persons. APA
encourages HRSA to maintain a strong emphasis on serving rural veteran
populations and their families. There is a growing need for highly
trained mental and behavioral health professionals to deliver evidence-
based services to the rapidly aging population. APA encourages HRSA to
reinstate the geropsychology component, and help integrate health
service psychology trainees at federally Qualified Health Centers.
HHS programs on aging.--Given that approximately 20-25 percent of
older adults have a mental or behavioral health problem, and older
white males (age 85 and over) currently have the highest rates of
suicide of any group in the U.S. APA supports an expanded effort to
address the mental and behavioral health needs of older adults
including implementation of the mental and behavioral health provisions
in the Older Americans Act Amendments of 2006, grants to States for the
delivery of mental health screening, and treatment services for older
individuals and programs to increase public awareness and reduce the
stigma associated with mental disorders in older individuals.
APA also recommends continued support of the HHS's Lifespan Respite
Program. Respite care can provide family caregivers with relief
necessary to maintain their own health, bolster family stability and
well-being, and avoid or delay more costly nursing home or foster care
placements.
Department of Education.--APA supports strengthening our Federal
investment in gifted and talented education and encourages Congress to
fund the Javits Gifted and Talented Education Program in fiscal year
2015, funded last year at $5 million. And, as a member of the Friends
of the Institute of Education Sciences (IES), APA supports $202.3
million for IES's research, development and dissemination portfolio,
consistent with the Administration's 2013 and 2014 requests. This would
support critical investments to provide evidence-based information on
effective educational practices to parents, teachers and schools, and
new research to fill gaps in knowledge.
Thank you for the opportunity to submit testimony for the record in
support of critical program areas funded by the Labor-Health and Human
Services-Education appropriations bill.
______
Prepared Statement of the American Public Health Association
The American Public Health Association is a diverse community of
public health professionals who champion the health of all people and
communities. We are pleased to submit our request to fund the Centers
for Disease Control and Prevention at $7.8 billion and the Health
Resources and Services Administration at $7.48 billion in fiscal year
2015. We urge you to take our recommendations to restore funding to at
least fiscal year 2010 levels into consideration as you move forward
with writing the fiscal year 2015 Labor-HHS-Education Appropriations
bill.
Centers for Disease Control and Prevention
APHA believes Congress should support CDC as an agency, not just
the individual programs that it funds. Given the challenges and burdens
of chronic disease and disability, public health emergencies, new and
reemerging infectious diseases and other unmet public health needs, we
urge a funding level of $7.8 billion for CDC's programs in fiscal year
2015. We appreciate some of the important new investments in President
Obama's fiscal year 2015 budget proposal; however, under the
president's proposal, CDC's total budget would be cut by nearly $243
million compared to fiscal year 2014. CDC's budget authority under the
president's budget is lower than fiscal year 2003 levels. State and
local health departments continue to operate on tight budgets and with
a smaller workforce, losing more than 50,000 public health jobs since
2008. These cuts will reduce the ability of CDC and its State and local
grantees to investigate and respond to public health emergencies,
ensure adequate immunization rates and track environmental hazards.
By translating research findings into effective intervention
efforts, CDC is a critical source of funding for many of our State and
local programs that aim to improve the health of communities. Perhaps
more importantly, Federal funding through CDC provides the foundation
for our State and local public health departments, supporting a trained
workforce, laboratory capacity and public health education
communications systems. It is notable that more than 70 percent of
CDC's budget supports public health and prevention activities by State
and local health organizations and agencies, national public health
partners and academic institutions.
CDC also serves as the command center for our Nation's public
health defense system against emerging and reemerging infectious
diseases. With the potential onset of a worldwide influenza pandemic
and the many other natural and man-made threats that exist in the
modern world, CDC has become the Nation's--and the world's--expert
resource and response center, coordinating communications and action
and serving as the laboratory reference center. States and communities
rely on CDC for accurate information and direction in a crisis or
outbreak.
CDC serves as the lead agency for bioterrorism and other public
health emergency preparedness and response programs and must receive
sustained support for its preparedness programs in order for our Nation
to meet future challenges. Given the challenges of terrorism and
disaster preparedness, and our many unmet public health needs and
missed prevention opportunities we urge you to provide adequate funding
for State and local capacity grants. Unfortunately, this is not a
threat that is going away.
CDC plays a significant role in addressing chronic diseases such as
heart disease, stroke, cancer, diabetes and arthritis that continue to
be the leading causes of death and disability in the United States.
These diseases, many of which are preventable, are also among the most
costly to our health system. CDC's National Center for Chronic Disease
Prevention and Health Promotion provides critical funding for State
programs to prevent chronic disease, conducts surveillance to collect
data on disease prevalence and monitor intervention efforts and
translates scientific findings into public health practice in our
communities.
CDC's National Center for Environmental Health is essential to
protecting the health and well being of the public by helping to
control asthma, protect from threats associated with climate change and
reduce exposure to lead and other hazards. We urge the subcommittee to
provide adequate funding for NCEH which has been significantly cut in
recent years.
Health Resources and Services Administration
HRSA operates programs in every State and U.S. territory and is a
national leader in improving the health of Americans through the
delivery of quality health services and supporting a well prepared
workforce. The agency serves the health needs of people who are
medically vulnerable, low-income and geographically isolated. The
Nation faces a shortage of health professionals and continues to
experience an ever growing, aging and increasingly diverse population,
alongside health professionals that are nearing retirement age. We are
deeply concerned that since fiscal year 2010, HRSA's discretionary
budget authority has been cut by 19 percent in nominal dollars and 25
percent when adjusted for inflation. Funding for HRSA is far too low
and keeping austerity measures in place will threaten the agency's
ability to address the present and growing health needs of the U.S. To
respond to the needs of our Nation, APHA recommends restoring funding
to the fiscal year 2010 level of $7.48 billion for discretionary HRSA
programs in fiscal year 2015.
HRSA programs have a strong history of providing quality care to
keep people healthy and improve health equity for those living outside
of the economic and medical mainstream. HRSA has contributed to the
decrease in infant mortality rate, a widely used indicator of the
Nation's health, which is now at an all-time low. Most recently,
preliminary data indicates that the infant mortality rate for black
infants has decreased, resulting in a narrowing of the gap that exists
between racial groups. HIV/AIDS programs administered by HRSA provide
access to regular care and ensure adherence to antiretroviral treatment
for people living with HIV, which reduces HIV transmission by 96
percent and greatly contributes to the prevention of new HIV
infections. A committed investment from Congress is required to
continue achieving the health improvements HRSA has made and to pave
the way for new achievements.
Our recommendation is based on the need to continue improving the
health of Americans by supporting critical HRSA programs, including:
--Health Professions supports the education and training of a broad
range of health professionals. With a focus on primary care and
training in interdisciplinary, community-based settings, these
are the only Federal programs focused on filling the gaps in
the supply of health professionals, as well as improving the
distribution and diversity of the workforce so health
professionals are well-equipped to care for the growing and
changing population.
--Primary Care supports 9,200 health sites in every State and U.S.
territory, improving access to care for more than 21 million
patients in geographically isolated and economically distressed
communities. Close to half of these health centers serve rural
populations. In addition, health centers target populations
with special needs, including migrant and seasonal farm
workers, homeless individuals and families and those living in
public housing.
--Maternal and Child Health including the Title V Maternal and Child
Health Block Grant, Healthy Start and others support
initiatives designed to promote optimal health, reduce
disparities, combat infant mortality, prevent chronic
conditions and improve access to quality healthcare for more
than 43 million women and children, including children with
special healthcare needs.
--HIV/AIDS provides assistance to States and communities most
severely affected by HIV/AIDS. The programs deliver
comprehensive care, prescription drug assistance and support
services for about half of the total population--1.1 million
people--living with HIV/AIDS in the U.S. Additionally, the
programs provide education and training for health
professionals treating people with HIV/AIDS and work toward
addressing the disproportionate impact of HIV/AIDS on racial
and ethnic minorities.
--Family Planning Title X services ensure access to a broad range of
reproductive, sexual and related preventive healthcare for over
5 million poor and low-income women, men and adolescents at
nearly 4,400 health centers nationwide. This program helps
improve maternal and child health outcomes and promotes healthy
families.
--Rural Health improves access to care for the nearly 50 million
people living in rural areas that experience a persistent
shortage of healthcare services. These programs are designed to
support community-based disease prevention and health promotion
projects, help rural hospitals and clinics implement new
technologies and strategies and build health system capacity in
rural and frontier areas.
Conclusion
In closing, we emphasize that the public health system requires
stronger financial investments at every stage. This funding makes up
less than 1 percent of Federal spending and continued austerity
measures that cut funding for public health and prevention programs
will not balance our budget and will only lead to increased costs to
our healthcare system. Successes in biomedical research must be
translated into tangible prevention opportunities, screening programs,
lifestyle and behavior changes and other population-based interventions
that are effective and available for everyone. Without a robust and
sustained investment in our public health agencies, we will fail to
meet the mounting health challenges facing our Nation.
[This statement was submitted by Georges Benjamin, MD, Executive
Director American Public Health Association.]
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM), the largest single
life science Society with over 39,000 members, wishes to submit a
statement in support of increased funding in the fiscal year 2015
budget for the Centers for Disease Control and Prevention (CDC). As the
Nation's health protection Agency, the CDC's programs are critical to
preventing disease and injury. The CDC conducts scientific
investigations, develops public health guidelines and provides
information and expertise in response to threats against public health
in the United States and worldwide.
The ASM urges Congress to approve the requested budget of $445.3
million for the National Center for Emerging and Zoonotic Infectious
Diseases (EZID), an overall increase of $54.9 million over fiscal year
2104. The EZID budget includes an increase of $31 million for Core
Infectious Diseases. A funding level of $30 million is included for
Advanced Molecular Detection (AMD), year 2 of the 5 year initiative to
enhance CDC's microbiology and bioinformatics capabilities to detect
and respond to infectious disease outbreaks. The AMD initiative will
improve pathogen identification and detection; adapt new diagnostics to
meet evolving public health needs; help States meet future reference
testing needs in a coordinated manner; implement enhanced, sustainable
and integrated laboratory information systems; and develop prediction
modeling and early recognition tools. Advances in biotechnology and
computing must be part of CDC efforts against the threat of infectious
diseases. Because of the need for better molecular sequencing tools and
bioinformatics, last year CDC proposed the AMD initiative, integrating
cutting edge laboratory and computer tools to enhance infectious
disease prevention and control. A 2013 pilot study tracking a Listeria
outbreak demonstrated that AMD technologies and methods could detect
outbreaks sooner, halting disease faster. The study used whole genome
sequencing with diagnostic testing for the first time to help clarify
which patients' illnesses were related to a listeriosis outbreak linked
to contaminated cheese. Listeria ranks third as a cause of death from
foodborne pathogens in the United States and sickens about 1,600 people
each year.
The EZID budget includes a $10 million increase for CDC's Food
Safety program. This increase is essential to enhance national
surveillance outbreak detection and response and food safety prevention
efforts. It will help modernize PulseNet and apply advanced DNA
technology and expand sites for FoodCORE to improve outbreak detection
and response. It will improve foodborne disease tracking, detection and
response through the Integrated Food Safety Center of Excellence. Food
safety is one of CDC's foremost strategic goals and heavily reliant
upon state of the art surveillance. Last year, the CDC published first
ever estimates of which food types were causing foodborne illnesses in
the United States. These attribution estimates guide regulators,
industry and consumers toward more precise and effective measures to
prevent food contamination. In June, a new CDC report identified the
key demographic groups most affected by Listeria bacteria infections.
During 2009--2011, twelve Listeria outbreaks sickened people in 38
States. CDC partnerships with other public health agencies clearly
extend the CDC's ability to prevent disease. For example, data from the
Foodborne Diseases Active Surveillance Network (FoodNet) are the source
for CDC's most recent annual food safety report, which showed that 2012
rates of infection for two foodborne pathogens (Campylobacter and
Vibrio) had increased significantly when compared to 2006--2008, while
rates of most others have not changed during the same period. FoodNet
involves CDC, ten State health departments, the Department of
Agriculture and the Food and Drug Administration.
The ASM strongly supports the fiscal year 2015 EZID budget request
of $30 million for the Antibiotic Resistance (AR) Strategy, which will
speed up outbreak detection through regional labs, support development
of new antibiotics and diagnostics and improve infection prevention and
antibiotic prescribing. With a $30 million annual funding for 5 years,
the AR initiative could achieve reductions in many infections,
including C. difficile, carbapenem resistant Enterobacteriaceae (CRE),
Multidrug Resistant (MDR) Pseudomosas, Invasive Methicillin-resistant
Staphylococcus aureus (MRSA) and MDR Salmonella.
CDC efforts have intensified against microbial pathogens that have
evolved resistance against known drug therapies. In September, a
landmark CDC report warned that antimicrobial resistant infections
infect more than two million people in the United States every year,
causing at least 23,000 deaths. CDC ranked AR threats into three
categories: urgent, serious and concerning. Infections classified as
urgent include CRE, drug resistant gonorrhea and Clostridium difficile,
a diarrheal infection that causes about 250,000 U.S. hospitalizations
and at least 14,000 deaths annually. Last year, CDC data showed more
patients at hospitals and long term care facilities are being diagnosed
with CRE infections; other AR reports are equally alarming.
In November, CDC joined with the American Academy of Pediatrics to
slow AR expansion with new guidelines, ``Principles of Judicious
Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections
in Pediatrics.'' Every year, up to 10 million children in the United
States risk side effects from antibiotic prescriptions unlikely to help
their respiratory symptoms. Many of these infections are caused by
viruses not treatable by antibiotics. Antibiotic use is the single most
important factor in antibiotic resistance, with up to 50 percent of
prescriptions unnecessary or prescribed inappropriately. Studies
estimate that AR adds $20 billion in excess direct health costs, with
additional costs to Society for lost productivity as high as $35
billion a year.
CDC guidelines that include science based prevention protocols can
be very effective, for example, the ongoing battle against healthcare
acquired infections (HAIs). About 1 in every 20 hospitalized patients
develops an infection caused by receiving medical care. Many of these
are drug resistant (e.g., three quarters of Staphylococcus aureus
infections in hospital ICUs are methicillin resistant MRSA). CDC
aggressively promotes use of prevention protocols in all facilities in
the United States. In 2013, CDC found that bloodstream infections in
patients with central IV lines had decreased by over 40 percent and
surgical site infections by 20 percent since 2008 and that following
CDC protocols could cut dialysis related bloodstream infections in
half. Another CDC coauthored report last fall concluded that there were
an estimated 30,800 fewer invasive MRSA infections in 2011 compared
with 2005. More than 12,000 healthcare facilities now track HAI
infections using CDC's National Healthcare Safety Network (NHSN).
Surveillance and Response
CDC depends upon extensive surveillance networks and unique rapid
response mobilization. Sustaining these CDC capabilities is critical to
detect health threats, halt outbreaks and prevent illness and injury.
Familiar threats like hepatitis and HIV/AIDS continue to affect lives.
Public health institutions also are repeatedly challenged by emerging
infectious diseases (EIDs), unexpected and often dangerous. CDC
regularly confronts new threats, including the following EIDs in the
past year:
--CDC scientists traced the newly discovered Heartland virus that
infected two men from Missouri to lone star ticks in the
region, adding another tick borne disease to those the CDC
monitors.
--NCEZID helped identify a novel poxvirus (the same genus as
smallpox) afflicting shepherds in the Republic of Georgia and
is developing new diagnostic tests.
--International travel advisories released by CDC address threats
posed by the new coronavirus MERS-CoV, first reported by Saudi
Arabia in 2012. CDC is working with health departments,
hospitals and other partners to prepare for possible cases in
the United States.
--CDC is monitoring new reports of the mosquito borne chikungunya
virus among residents of St. Martin in the Caribbean, the first
time the disease has been detected among non-travelers in the
Western Hemisphere.
In 2013, CDC updated new surveillance results on several infectious
diseases with serious healthcare and economic consequences in the
United States:
--Each year there are about 19 to 21 million cases of norovirus
illness, about 570 to 800 people die, and many thousands more
are hospitalized or visit emergency rooms and outpatient
clinics. Another CDC study found that the contagious stomach
virus is now the leading cause of acute gastroenteritis among
children less than 5 years of age who seek medical care. It
caused nearly one million U.S. pediatric visits in 2009--2010.
--About 300,000 people are diagnosed with Lyme disease each year in
the United States, making it the most commonly reported tick
borne illness. The early estimate is based on findings from
three ongoing CDC studies. It suggests that the total number is
roughly 10 times higher than the number reported to CDC by
healthcare providers.
--Valley Fever, a fungal respiratory infection, dramatically
increased in several southwestern States, from 2,265 in 1998 to
more than 22,000 in 2011. CDC is investigating whether the
increase is related to changes in weather, rising populations
or changes in the way the disease is detected and reported to
the States or CDC.
Each year, CDC gives financial support to all 50 State health
departments, six local departments, and eight territories or
affiliates. Since 2010, CDC has provided funds to 57 State, local and
territorial health departments to increase the use of electronic lab
reporting (ELR). About 10,400 labs send reportable data to health
agencies but many do not report electronically.
Global Health
With globalization of our food supply and frequent travel to and
from the United States, health security threats can come from anywhere.
CDC's Center for Global Health and Office of Infectious Diseases
oversee Agency efforts to prevent, detect and respond to outbreaks in
other countries. There are more than 1,600 CDC employees located in
over 60 countries. At present, only 1 in 5 countries can rapidly
detect, respond to or prevent global health threats caused by emerging
infections. Improvements overseas, such as strengthening surveillance
and lab systems or training investigators, make both the United States
and the rest of the world more secure against infectious disease.
In January, CDC reported results from pilot projects in Uganda and
Vietnam to improve disease detection and response capabilities. Work in
Uganda modernized diagnostic testing, developed real time information
systems for faster outbreak response and improved emergency operations
procedures. It focused on three priority diseases, drug resistant
tuberculosis, cholera and viral hemorrhagic fever caused by Ebola
virus. The Vietnam project trained Vietnamese health officials in
advanced PCR techniques to detect H7N9 influenza, enterovirus 71 and
respiratory viruses.
The ASM strongly urges Congress to increase CDC's budget in fiscal
year 2015 to the highest level possible and approve funding increases
for infectious diseases.
______
Prepared Statement of the American Society for Microbiology
The American Society for Microbiology (ASM), the largest single
life science Society with over 39,000 members, wishes to submit the
following comments and recommendations for the record on the fiscal
year 2015 budget for the National Institutes of Health (NIH). The ASM
commends Congress for passage of the fiscal year 2014 Omnibus
Appropriations Bill which represents a step in the right direction
although funding for NIH remains too low in view of the gaps in our
knowledge of disease and the abundance of scientific opportunities that
cannot be pursued because of lack of funding. The ASM recommends that
NIH receive at least $32 billion in fiscal year 2015 as the next step
toward a multi-year increase in the Nation's investment in medical
research.
The ASM is very concerned about the future of biomedical research
in the United States. NIH support for basic research is critical to
health and security, job creation and growing the U.S. economy. In
fiscal year 2013, the success rate for NIH research grant applicants
fell to an historic low 16.8 percent. The average size of research
project grants (RPGs) decreased to the lowest ever since 1999. During
last year's sequestration, there were reports of delayed research
projects, enforced layoffs of technical staff and waning innovation.
Such stagnation undercuts biomedical research progress in the United
States at a time when the opportunities are great and other Nations are
growing their investment in basic and translational biomedical
research.
NIH is the primary supporter of biomedical research in the Nation.
In 2012 alone, NIH funding supported more than 402,000 jobs and $57.8
billion in new economic activity nationwide. Among NIH's investments
are those in the rapidly advancing field of genomics. A recent report
from the nonprofit United for Medical Research (UMR) spotlighted the
economics of Federal investment in the human genome project, which has
generated $965 billion in economic impact, more than 53,000 direct
genomics related jobs and $293 billion in personal income.
Current trends in the Nation's R&D investments clearly do not bode
well for future innovation and global competition. Federal R&D
expenditures declined by 16.3 percent between fiscal years 2010 and
2013, while China's investment jumped more than 400 percent over the
past decade. Since 2001, the U.S. share of global R&D performed has
decreased from 37 percent to 30 percent. The Science Coalition Report
in 2013 highlighted the importance of federally funded university
research in creating new companies and R&D jobs. The report profiles
R&D companies launched by relatively small Federal investment in
university research, including NIH grants funding rapid pathogen
detection technologies, vaccine development and advances in food and
water safety.
Several UMR reports from last year underscore how NIH supported
research can propel private sector growth and innovation. U.S. biotech
companies catalyzed by NIH funding illustrate the productive
collaborations among NIH, university research scientists and the
private sector. These companies are reshaping lucrative R&D sectors
like gene sequencing and therapeutics for human disease, taking basic
research to the marketplace. NIH support is responsible for several of
Science magazine's top ten 2013 discoveries, all expected to return
huge dividends, including the ``breakthrough of the year'' cancer
immunotherapy, the new gene editing CRISPR technique and the
astoundingly important human microbiome project.
Also included was the first use of structural biology techniques to
custom design a powerful immunogen with vaccine potential, in this case
against respiratory syncytial virus (RSV). Worldwide, about 64 million
cases of RSV infection occur each year, responsible for 160,000 deaths,
making it the most common cause of severe respiratory illness in
infants and young children. There is no approved vaccine, but the team
led by NIAID Vaccine Research Center identified 3-D structures of
attachment sites on the virus surface and potent antibodies against
those sites, offering new tools to develop new or improved vaccines.
NIH investments build the scientific foundation for the Nation's
valuable biomedical R&D sector, which employs 7 million and exports $90
billion in goods and services. In 2013, all three recipients of the
Nobel Prize in Physiology or Medicine and all three winners of the
Nobel Prize in Chemistry had at some point received NIH funding (for a
total of 144 NIH supported Nobel laureates). Four NIH funded scientists
also won prestigious 2013 Lasker Foundation awards.
As the Nation's largest funder of biomedical research, NIH leads
the Nation's efforts to discover new cures, preventions and therapies
for difficult disease challenges by funding intramural and extramural
projects to combat infectious diseases that kill millions of people
worldwide. The National Institute of Allergy and Infectious Diseases
(NIAID) and the National Institute of General Medical Sciences (NIGMS)
contribute to new, paradigm shifting technologies like high throughput
genomic sequencing, as well as new multidisciplinary research
approaches like systems biology.
NIAID funded scientists have discovered therapies, vaccines,
diagnostic tests and other biomedical tools that improve human health.
Lifesaving examples are vaccines for rabies, meningitis, whooping
cough, hepatitis A and B, chickenpox and pneumococcal pneumonia.
Developing new influenza vaccines is a high priority for NIAID, which
has supported a health provider consortium for clinical trials since
the 1960s. The NIAID Vaccine Research Center's influenza research has
produced multiple promising advances like a DNA vaccine against H5N1
avian influenza and it helped establish the Southeast Asia Influenza
Clinical Research Network to address global influenza threats. Ongoing
NIAID research is making progress toward the highly significant goal of
a universal influenza vaccine that would confer decades long protection
from any flu virus strain.
In February, NIAID reported on its latest contributions in the
battle to halt antimicrobial resistance (AR) spreading among pathogens,
which is creating ever more dangerous diseases like multidrug resistant
gonorrhea and extensively drug resistant tuberculosis. Each year, there
are 2 million drug resistant infections and 23,000 deaths in the United
States. Annual costs are an estimated $20 billion in added healthcare
and $35 billion in lost productivity. NIAID leads U.S. research against
drug resistant pathogens, making major investments in basic,
translational and clinical research. Results include advances in
prevention, diagnosis and treatment of AR infections, as well as
greater support for new drug discovery. The agency has helped support
R&D of at least 25 percent of the antibiotics currently in clinical
testing. Basic AR research funded by NIAID is detailing the ways that
pathogens evade host defenses, to identify new therapeutic and
diagnostic targets. Using the latest in technological tools, NIAID
supported researchers are developing novel diagnostics platforms for
more rapid and accurate detection of emerging AR infections. NIAID's
expansive AR portfolio also includes vaccine development against
increasingly common AR threats like drug resistant staph and gonorrhea
bacteria.
One of NIAID's greatest challenges for the 21st century is
developing defenses against familiar enemies, the world's three
greatest microbial killers, HIV/AIDS, malaria and tuberculosis. Recent
research advances include the following:
--A novel compound, from a new class of potential antimalarial drugs,
appears effective against multiple life stages of the malaria
causing Plasmodium parasite. Most antimalarials only target the
parasite as it grows in the host's bloodstream, giving the
parasite more chances to spread and acquire drug resistance.
--After designing nanoparticles loaded with copies of mutated HIV
selected via computerized screening, scientists have activated
host immune cells to produce VRC01 neutralizing antibodies. The
approach offers a new tool to potentially reverse engineer
neutralizing antibodies against HIV and other viruses.
--Using a systems biology approach, scientists have identified
interactions among genetic regulators in Mycobacterium
tuberculosis (Mtb), the bacterium that causes tuberculosis
(TB). The results help explain how Mtb lies latent for long
periods in otherwise healthy people, then becomes active and
transmissible TB. About one third of the world's population is
infected, making Mtb switches between different stages crucial
to public health.
Research strategies clearly rely upon previous scientific
successes. Ever shifting influenza viruses and steady evolution of AR
pathogens illustrate how any effort must build upon the past, respond
to the present and plan for the future. New microbial threats emerge as
old threats persist, the recent spread of dengue fever, detection of
influenza H7N9 last year and the newly emerging coronavirus caused
Middle East respiratory syndrome (MERS). First identified in 2012,
MERS-CoV infection has been implicated in 181 cases (as of February 4)
and 79 deaths. With high mortality and no treatments, the disease's
spread from the Middle East to Europe has health officials concerned.
NIAID funded researchers now have reported some laboratory success
using potential MERS-CoV therapy that combines two licensed antiviral
drugs routinely used to treat diseases such as hepatitis C.
At NIGMS, microbial genetics and cell/molecular biology are
principal research emphases, recognition that microbiology not only
provides insights to human health and biology in general, but also
stimulates innovation in U.S. biotechnology. Each year, NIGMS awards
more than 4,500 research grants and supports one fourth ( 4,000) of the
NIH supported technical trainees.
NIGMS funded research has generated high value technologies like
PCR, high throughput DNA sequencing, and the human genome project. The
latest exciting biotech tool to emerge is CRISPR technology (Clustered
Regularly Interspaced Short Palindromic Repeats, DNA loci in bacterial
genomes), innovation that evolved from basic research in both phage
biology and advanced computing genomics. With huge potential for
improved genome editing essential to the biotech industry, today the
CRISPR system is increasingly used in gene cutting and other customized
gene targeting.
Without sustained NIH funding in diverse fields like microbiology,
ASM strongly believes there will be fewer new discoveries and
innovation in the United States. We urge Congress to build on
bipartisan efforts to replace the random cuts of sequestration that
have been devastating to basic research in the United States and to
increase funding for the National Institutes of Health. Increased
investment will enable the scientific progress that is needed to
improve the health, security and economic growth of the country.
______
Prepared Statement of the American Society for Nutrition
Dear Chairwoman Mikulski and Ranking Member Shelby: Thank you for
the opportunity to provide testimony regarding fiscal year 2015
appropriations. The American Society for Nutrition (ASN) respectfully
requests $32 billion dollars for the National Institutes of Health
(NIH) and $182 million dollars for the Centers for Disease Control and
Prevention/National Center for Health Statistics (CDC/ NCHS) in Fiscal
Year 2015. ASN is dedicated to bringing together the world's top
researchers to advance our knowledge and application of nutrition, and
has more than 5,000 members working throughout academia, clinical
practice, government, and industry.
National Institutes of Health (NIH)
The NIH is the Nation's premier sponsor of biomedical research and
is the agency responsible for conducting and supporting 86 percent of
federally-funded basic and clinical nutrition research. Although
nutrition and obesity research makes up less than eight percent of the
NIH budget, some of the most promising nutrition-related research
discoveries have been made possible by NIH support. NIH nutrition-
related discoveries have impacted the way clinicians prevent and treat
heart disease, cancer, diabetes and other chronic diseases. For
example, U.S. death rates from heart disease and stroke have decreased
by more than 60 percent, and the proportion of older adults with
chronic disabilities has dropped by one-third. With additional support
for NIH, additional breakthroughs and discoveries to improve the health
of all Americans will be made possible.
Investment in biomedical research generates new knowledge, improved
health, and leads to innovation and long-term economic growth. A decade
of flat-funding, followed by sequestration cuts, has taken a
significant toll on NIH's ability to support research. Such economic
stagnation is disruptive to training, careers, long-range projects and
ultimately to progress. Increasing the NIH budget to $32 billion
dollars would fully restore the funding that was lost to sequestration
and support at least 600 additional competing research project grants.
As a first step toward sustainable growth, ASN recommends a minimum of
$32 billion dollars for NIH in fiscal year 2015. NIH needs sustainable
and predictable budget growth in order to fulfill the full potential of
biomedical research, including nutrition research, and to improve the
health of all Americans.
Centers for Disease Control and Prevention National Center for Health
Statistics (CDC NCHS)
The National Center for Health Statistics, housed within the
Centers for Disease Control and Prevention, is the Nation's principal
health statistics agency. ASN recommends a fiscal year 2015 funding
level of $182 million dollars for NCHS, consistent with the President's
budget request, to help ensure uninterrupted collection of vital health
and nutrition statistics, and help cover the costs needed for
technology and information security maintenance and upgrades that are
necessary to replace aging survey infrastructure. More than half of
NCHS's budget is supported through the evaluation tap. Therefore, ASN
does not support efforts to eliminate the evaluation tap--in part or in
full--unless a viable alternative funding mechanism is put in place to
continue these important functions.
The NCHS provides critical data on all aspects of our health care
system, and it is responsible for monitoring the Nation's health and
nutrition status through surveys such as the National Health and
Nutrition Examination Survey (NHANES), that serve as a gold standard
for data collection around the world. Nutrition and health data,
largely collected through NHANES, are essential for tracking the
nutrition, health and well-being of the American population, and are
especially important for observing nutritional and health trends in our
Nation's children.
Nutrition monitoring conducted by the Department of Health and
Human Services in partnership with the U.S. Department of Agriculture/
Agricultural Research Service is a unique and critically important
surveillance function in which dietary intake, nutritional status, and
health status are evaluated in a rigorous and standardized manner.
Nutrition monitoring is an inherently governmental function and
findings are essential for multiple government agencies, as well as the
public and private sector. Nutrition monitoring is essential to track
what Americans are eating, inform nutrition and dietary guidance
policy, evaluate the effectiveness and efficiency of nutrition
assistance programs, and study nutrition-related disease outcomes.
Funds are needed to ensure the continuation of this critical
surveillance of the Nation's nutritional status and the many benefits
it provides.
Through learning both what Americans eat and how their diets
directly affect their health, the NCHS is able to monitor the
prevalence of obesity and other chronic diseases in the U.S. and track
the performance of preventive interventions, as well as assess
`nutrients of concern' such as calcium, which are consumed in
inadequate amounts by many subsets of our population. Data such as
these are critical to guide policy development in the area of health
and nutrition, including food safety, food labeling, food assistance,
military rations and dietary guidance. For example, NHANES data are
used to determine funding levels for programs such as the Supplemental
Nutrition Assistance Program (SNAP) and the Women, Infants, and
Children (WIC) clinics, which provide nourishment to low-income women
and children.
To continue support for the agency and its important mission, ASN
recommends an FY 2015 funding level of $162 million for NCHS. Sustained
funding for NCHS can help to ensure uninterrupted collection of vital
health and nutrition statistics, and will help to cover the costs
needed for technology and information security upgrades that are
necessary to replace aging survey infrastructure.
Thank you for the opportunity to submit testimony regarding fiscal
year 2015 appropriations for the National Institutes of Health and the
CDC/National Center for Health Statistics. Please contact John E.
Courtney, Ph.D., Executive Officer, if ASN may provide further
assistance.
[This statement was submitted by Gordon M. Jensen, M.D., Ph.D.,
2013-2014 ident, American Society for Nutrition.]
______
Prepared Statement of the American Society for Pharmacology &
Experimental Therapeutics
The American Society for Pharmacology and Experimental Therapeutics
(ASPET) is pleased to submit written testimony in support of the
National Institutes of Health (NIH) fiscal year 2015 budget. ASPET
recommends a fiscal year 2015 NIH budget of at least $32 billion.
Sustained growth for the NIH should be an urgent national priority.
Congress showed bipartisan support for the agency in fiscal year 2014
as evidenced by the $1 billion increase above the fiscal year 2013
sequestered level. While this 3.5 percent increase helps put NIH on the
path to more sustainable funding levels, it does not begin to make up
for a lost decade of funding. Adjusting for inflation, the fiscal year
2013 budget for the NIH is less than it was in 2003. For NIH to meet
its vital role in improving public health, stimulating our economy, and
improving global competitiveness it is critical that the agency
continue to receive steady and sustainable increases.
Additionally, if funding for the next 10 years is similar to that
of the past decade, the Nation will lose a generation of young
scientists. Increasingly, these individuals, seeing no prospects for
careers in biomedical research, will leave the research enterprise or
look for employment in foreign countries. Not only are jobs
increasingly limited in the academic sector, but industry too is under
stress. The ``brain drain'' of young scientific talent jeopardizes the
Nation's leadership in biomedical research. A survey of ASPET's own
graduate students and post-doctoral researchers indicates that 45
percent of post-doctoral trainees and 25 percent of graduate students
say they are no longer considering a career in biomedical research due
to the restrictive funding environment; 50 percent of graduate students
and 29 percent of post-doctoral trainees say they are willing to
consider leaving the United States to pursue a career in biomedical
research.
A $32 billion budget for the NIH in fiscal year 2015 is a start to
help restore NIH's biomedical research capacity. Currently, the NIH
only can fund one in six grant applications, the lowest rate in the
agency's history. Furthermore, the number of research project grants
funded by NIH has declined every year since 2004.
A budget of at least $32 billion in fiscal year 2015 will help the
agency manage its research portfolio more effectively without having to
withhold funding for existing grants to researchers throughout the
country. Only through steady, sustained and predictable funding
increases can NIH continue to fund the highest quality biomedical
research to help improve the health of all Americans and continue to
make significant economic impact in many communities across the
country.
There is no substitute for a steady, sustained Federal investment
in biomedical research. Industry, venture capital, and private
philanthropy can supplement research but cannot replace the investment
in basic, fundamental biomedical research provided by NIH. Neither the
private sector nor industry will be able to fill a void for NIH funded
basic biomedical research. Much of industry support is applied research
that builds upon the discoveries generated from NIH-funded projects.
The majority of the investment in basic biomedical research that NIH
provides is broad and long-term providing a continuous development
platform for industry, which would not typically invest in research
that may be of higher risk and require several years to fully mature.
In addition to this long term view, NIH also has mechanisms in place to
rapidly build upon key technologies and discoveries that have the
ability to have significant impact on the health and well being of our
citizens.
Many of the basic science initiatives supported by NIH have led to
totally unexpected discoveries and insight that have transformed our
mechanistic understanding of and our ability to treat a wide range of
diseases
Diminished Support for NIH will Negatively Impact Human Health
Continued diminishment of funding and loss of purchasing power will
mean a loss of scientific opportunities to discover new therapeutic
targets. Without a steady, sustained Federal investment in fundamental
biomedical research, scientific progress will be slower and potentially
helpful therapies or cures will not be developed. For example, more
research is needed on Parkinson's disease to help identify the causes
of the disease and help develop better therapies; discovery of gene
variations in age-related macular degeneration could result in new
screening tests and preventive therapies; more basic research is needed
to focus on new molecular targets to improve treatment for Alzheimer's
disease; and diminished support for NIH will prevent new and ongoing
investigations into rare diseases that the Food and Drug Administration
estimates almost 90 percent are serious or life-threatening.
Historically, our past investment in basic biological research has
led to many innovative medicines. The National Research Council
reported that of the 21 drugs with the highest therapeutic impact, only
five were developed without input from the public sector. The
significant past investment in the NIH has provided major gains in our
knowledge of the human genome, resulting in the promise of
pharmacogenomics and a reduction in adverse drug reactions that
currently represent a major worldwide health concern. Several completed
human genome sequence analyses have pinpointed disease-causing variants
that have led to improved therapy and cures but further advances and
improvements in technology will be delayed or obstructed with
diminished NIH funding.
Investing in NIH Helps America Compete Economically
A $32 billion budget in fiscal year 2015 will also help the NIH
train the next generation of scientists and provide a platform for
broader workforce development that is so critical to our Nation's
growth. Many individuals trained in the sciences through NIH support
become educators in high schools and colleges. These individuals also
enter into other aspects of technology development and evaluation in
public and private sectors to further enrich the community and
accelerate economic development.
This investment will help to create jobs and promote economic
growth. A stagnating NIH budget will mean forfeiting future discoveries
and jobs to other countries.
The U.S. share of global research and development investment from
1999-2009 is now only 31 percent, a decline of 18 percent. In contrast,
other nations continue to invest aggressively in science. China has
grown its science portfolio with annual increases to the research and
development budget averaging over 23 percent annually since 2000,
including a 26 percent increase in 2012. Russia plans to increase
support for research by 65 percent over the next 5 years. The European
Union, despite great economic distress among its member nations, has
proposed to increase spending on research and innovation by 45 percent
between 2014 and 2020.
NIH research funding catalyzes private sector growth. More than 83
percent of NIH funding is awarded to over 3,000 universities, medical
schools, teaching hospitals and other research institutions in every
State. One national study by an economic consulting firm found that
Federal (and State) funded research at the Nation's medical schools and
hospitals supported almost 300,000 jobs and added nearly $45 billion to
the U.S. economy. NIH funding also provides the most significant
scientific innovations of the pharmaceutical and biotechnology
industries.
Conclusion
ASPET appreciates the many competing and important spending
decisions the Subcommittee must make. However, the NIH's contribution
to the Nation's economic and physical well being should make it one of
the Nation's top priorities. With enhanced and sustained funding, NIH
can begin to reverse its decline and help meet its potential to address
many of the more promising scientific opportunities that currently
challenge medicine. A budget of at least $32 billion in fiscal year
2015 will allow the agency to begin moving forward to full program
capacity, exploiting more scientific opportunities for investigation,
and increasing investigator's chances of discoveries that prevent,
diagnose and treat disease. NIH should be restored to its role as a
national treasure, one that attracts and retains the best and brightest
to biomedical research and provides hope to millions of individuals
afflicted with illness and disease.
ASPET is a 5,100 member professional society whose members conduct
basic, translational, and clinical pharmacological research within the
academic, industrial and government sectors. Our members discover and
develop new medicines and therapeutic agents that fight existing and
emerging diseases, as well as increase our knowledge regarding how
therapeutics affects humans.
[This statement was submitted by James S. Bernstein, Director,
Government and Public Affairs, American Society for Pharmacology &
Experimental Therapeutics.]
______
Prepared Statement of the American Society of Clinical Oncology
The American Society of Clinical Oncology (ASCO), the world's
leading professional organization representing nearly 35,000 physicians
and other professionals who treat people with cancer, appreciates this
opportunity to provide the following recommendations for fiscal year
2015 (fiscal year 2015) funding:
--National Institutes of Health (NIH): $32 billion
--National Cancer Institute (NCI): $5.26 billion
ASCO's members set the standard for cancer care world-wide and lead
the way in carrying out translational and clinical research aimed at
improving the screening, prevention, diagnosis and treatment of cancer.
ASCO advocates for policies that provide access to high-quality care
for all patients with cancer. ASCO's efforts are also directed toward
supporting oncology clinical and translational research that is
critical to improving the lives of our citizens and that can inform
cancer services for people worldwide.
Cancer's Growing Footprint and the Importance of Federal Cancer
Research
According to ASCO's State of Cancer Care in America report (http://
www.asco.org/practice-research/cancer-care-america) released earlier
this year, cancer will surpass heart disease as the leading cause of
death in the United States (US) over the next 16 years. While cancer
deaths in the US are declining for all populations, the number of new
cancer cases is expected to increase nearly 45 percent by 2030, from
1.6 million cases to 2.3 million cases annually. The leading overall
risk factor for cancer is aging and these numbers reflect overall
progress in healthcare, enabling more Americans to live longer.
While we have made great strides in cancer treatment, now is not
the time to cut back as cancer impacts more and more Americans. We now
have more cancer survivors alive today than at any point in our history
and understand more about the diseases that make up cancer than ever
before. This is largely because of Federal investment in cancer
research, but we will not be able to harness the opportunities this new
knowledge provides without further investment. Adjusting for inflation,
funding for the NIH is down 23 percent since 2003. In addition, the NCI
has become a smaller share of NIH's total budget. If NCI was funded as
the same percentage of overall NIH spending that it was in 2003, it
would mean an additional $350 million for cancer research.
ASCO thanks the subcommittee for its past commitment to cancer
research through the appropriations process and appreciates the unique
effort made by the subcommittee in this challenging budget environment.
We recognize the challenging environment, but caution that the current
path of investment in cancer research will be devastating to attempts
to find future cures. ASCO calls on this subcommittee to renew the
commitment to clinical cancer research--without which our basic science
findings would never help improve the lives of patients.
While we appreciate the bipartisan efforts that led to a brief
reprieve from sequester in fiscal year 2015, the lasting effects of
these draconian cuts, exacerbated by years of stagnant funding, will be
felt for decades to come if the trend is not reversed. ASCO released a
survey (http://www.asco.org/press-center/asco-survey-underscores-
%E2%80%9Cdevastating%E2%80%9D-impact-stagnant-funding-cancer-research)
of its members in September 2013 that showed the profound impact of
sequester on the U.S. cancer research enterprise.
A large majority, 75 percent, of survey respondents, reported that
the current Federal funding situation is having a direct impact on
their ability to conduct cancer research, in many cases triggering
``devastating'' changes. Delayed clinical trials, the elimination of
research staff positions, and the halting or slowing of promising
research that could lead to new therapies for cancer were cited as
specific results of stagnant funding.
In order to stop these devastating trends and capitalize on forward
progress, the NIH and the NCI must have sustained and predictable
increases in funding. While private industry is a strong partner in
cancer research, they do not conduct the broad scope of clinical
research that is important to cancer patients. In contrast, the NCI
conducts the high risk, high reward research that leads to practice-
changing advancements that industry is often unwilling to undertake--
such as pediatric applications, direct comparisons of approved drugs,
and providing drugs in combination with or prior to radiation or
surgical treatments. Progress in fighting cancer would be faster, more
efficient, and more sustainable if funding were steady and sustained.
Our prior investments established the global leadership of American
cancer research and care. Without maintenance of those investments, our
global leadership and the benefits it offers everyday Americans in both
health and economically are profoundly threatened.
Clinical Trials and Translational Research
NIH-funded translational research and clinical trials have
significantly improved the standard of care in many diseases. At the
same time, they also have demonstrated more cost-effective treatment
options for many common cancers. Unfortunately, these trials are at
risk, due to funding concerns that slow the launch and completion of
trials. Of great concern is the deterioration of NCI support for
federally funded trials that take place in virtually every community in
which cancer providers treat patients. On March 1, 2014, the NCI
launched the reorganized National Clinical Trials Network (NCTN). The
program currently involves over 3,000 institutions and community-based
investigators in the US and provides approximately 17,000 patients with
access to promising new treatments each year, at a $243 million annual
cost to taxpayers. Due to funding constraints, the number of patients
enrolled in clinical trials has fallen from a peak of almost 30,000
patients in 2009 to a planned enrollment of only 12,000 adults in the
current fiscal year and some trials may be forced to close early
potentially depriving patients of access to life-prolonging treatments.
Please note that without patient accrual to clinical trials, there can
be no changes in routine care, practice, and outcomes. This is where
science becomes practice changing for patients in America.
We understand that March 1 also marked the end of funding for the
NCI Community Clinical Oncology Program (CCOP). NCI is transforming
this program into the NCI Community Oncology Research Program (NCORP).
NCI is currently reviewing NCORP applications and does not expect to
issue notices of award until September 2014. In the meantime, CCOP
sites have ongoing ethical obligations to active trial participants to
continue clinical trial procedures and required follow-up. At present,
community practice sites are expected to do so without any transition
in funding. These community sites are crucial to making cutting edge
cancer care available to patients in the communities where they live.
Without any assurance of sustained funding, some community sites will
no longer be able to offer clinical trials to patients.
Clinical trials supported by Federal funding have led to important
breakthroughs in cancer care that touch every American family and often
these are in areas that industry has no incentive to pursue. Typically,
the trial concepts are proposed directly by clinician investigators who
hypothesize ways to improve treatments for their patients and want to
test those hypotheses through rigorously designed prospective clinical
trials. Just as the NIH RO1 and R21 grant mechanisms inspire researcher
creativity and innovation, the NCTN and NCORP programs are important in
fostering research initiatives directly from clinician investigators
who see firsthand the importance of answering questions vital to their
patients. Publicly funded clinical trials involve establishing
comparative effectiveness, examining promising regimens, optimizing
multimodality treatments, developing therapies for rare cancers, and
studying prevention and survivorship strategies. These research goals
may run parallel to those of commercial sponsors, but publicly funded
trials are designed to benefit patients--not intended to achieve
regulatory approval or shareholder interest. Many of these trials are
at risk due to funding constraints and the pace of further progress,
especially against the most common cancers in America, will slow. For
example, at the present time there is no publically funded breast
cancer adjuvant treatment trial available in the US.
ASCO's Clinical Cancer Advances report (http://
www.cancerprogress.net/clinical-cancer-advances-2013) provides annual
recognition of the major advances in patient treatments and care. The
2013 report details 76 research advances, 27 of which received NIH
funding, in diseases impacting an estimated 1.6 million patients last
year alone. Its top areas of progress include: using genomics to make
treatment decisions for individual patients, discovering new cancer
subtypes specifically associated with potential new therapies, tackling
treatment resistant forms of cancer through precision medicine
approaches, enhancing the ability of patients' own immune systems to
fight cancer, and implementing new cancer screening paradigms to reduce
disparities.
To maintain global American scientific leadership, ASCO urges a
substantial increase in funding for the National Clinical Trials
Network and NCI Community Oncology Research Program, as well as
transition funding for CCOP sites until NCORP launches. ASCO is very
concerned that the Federal funding situation is causing NCI to propose
capping patient participation in clinical trials in order to stretch an
ever-shrinking funding pot. NCI acknowledges that current payments are
inadequate to cover the costs of conducting trials because they have
not increased over nearly a decade. Making the needed increases at the
expense of new scientific opportunities, however, is short-sighted and
has long-term negative implications. The Institute of Medicine (IOM)
recognized this in its 2010 report, A National Cancer Clinical Trials
System for the 21st Century: Reinvigorating the NCI Cooperative Group
Program. The IOM pointed to the notable achievements of Cooperative
Group trials that have dramatically improved the outcomes of today's
cancer patients and recognized that increases in funding should
accompany the changes that the NCI and Cooperative Groups have already
implemented to increase the efficiency of their operations and to keep
pace with scientific opportunity. An increase in NCI funding would
enable the Institute to maintain or increase the number of accruals to
trials at the same time as it increases payments to cover the cost of
conducting the research.
Threat to America's Global Leadership
While the United States is slowing its investment in medical
research, countries around the globe are making significant increases
to theirs. Russia is increasing basic research funding by 65 percent,
European investments are increasing by 40 percent over 7 years, South
Korea has pledged a 50 percent increase, and China announced a 26
percent boost in basic research funding in 2012. These investments
result not only in additional research in these countries, but are
attracting the best and brightest American-trained scientists to work
abroad. The long-term consequences are easy to predict. If scientific
progress is achieved elsewhere, Americans will be asked to import new
treatments including drugs, intellectual property, and products.
The previously referenced ASCO survey also revealed the disturbing
finding that many young investigators are leaving the field altogether
due to lack of funding. This too is a predictable effect of funding
limits. With more than 35 percent of survey participants reporting
having to lay off skilled staff, many appear to be questioning the
viability of a career in research and raising serious concerns about
the ultimate impact of budget cuts on patient care and outcomes.
Declining Federal funding for clinical trials, coupled with the
rising costs of increasingly complex studies, will severely harm the
nation's clinical research enterprise by limiting opportunities for
innovation and demoralizing young clinical investigators. As
opportunities to develop and lead trials diminish and institutional
pressures to generate research funding and clinical revenue continue to
grow, young investigators may leave the field of research, or choose to
pursue research opportunities in other countries. Not only does this
threaten our progress against cancer, but it also diminishes the
overall scientific workforce in America.
In addition, clinical trials are increasingly being conducted
overseas, due to the costs and regulatory complexities of conducting
trials in the US. This denies your constituents the opportunity to
participate, either as a patient receiving the most promising potential
treatment or as a physician or research nurse conducting the clinical
trial. Congress should demonstrate a continued commitment to ensure
biomedical research is federally funded.
Because of the incredible scientific opportunities facing us and
the current threats to this opportunity, ASCO urges the NIH and NCI to
focus more of its resources in the area of clinical trials and
translational research.
ASCO again thanks the Subcommittee for its continued support of
cancer patients in the US through funding for the NIH and the NCI. We
look forward to working with all members of the subcommittee to advance
US cancer research.
[This statement was submitted by Clifford A. Hudis, MD, FACP,
President, American Society of Clinical Oncology.]
______
Prepared Statement of the American Society of Hematology
The American Society of Hematology (ASH) thanks the Subcommittee
for the opportunity to submit written testimony on the fiscal year 2015
Departments of Labor, Health and Human Services, and Education
Appropriations bill.
ASH represents more than 15,000 clinicians and scientists committed
to the study and treatment of blood and blood-related diseases. These
diseases encompass malignant disorders such as leukemia, lymphoma, and
myeloma; life-threatening conditions, including thrombosis and bleeding
disorders; and congenital diseases such as sickle cell anemia,
thalassemia, and hemophilia. In addition, hematologists have been
pioneers in the fields of bone marrow transplantation, stem cell
biology and regenerative medicine, gene- and immunotherapy, and the
development of many drugs for the prevention and treatment of heart
attacks and strokes.
Funding for Hematology Research: An Investment in the Nation's Health
Over the past 60 years, American biomedical research has led the
world in probing the nature of human disease. This research has led to
new medical treatments, saved innumerable lives, reduced human
suffering, and spawned entire new industries. This research would not
have been possible without support from the National Institutes of
Health (NIH).
Funding for hematology research has been an important component of
this investment in the Nation's health. Most of the research that
produced cures and treatments for hematologic diseases has been funded
by the NIH. The study of blood and its disorders is a trans-NIH issue
involving many institutes at the NIH, including the National Heart,
Lung and Blood Institute (NHLBI), the National Cancer Institute (NCI),
the National Institute of Diabetes, Digestive and Kidney Diseases
(NIDDK), and the National Institute on Aging (NIA).
With the advances gained through an increasingly sophisticated
understanding of how the blood system functions, hematologists have
changed the face of medicine through their dedication to improving the
lives of patients. As a result, children are routinely cured of acute
lymphoblastic leukemia (ALL); more than 90 percent of patients with
acute promyelocytic leukemia (APL) are cured with a drug derived from
vitamin A; older patients suffering from previously lethal chronic
myeloid leukemia (CML) are now effectively treated with well-tolerated
pills; and patients with multiple myeloma are treated with new classes
of drugs.
Additionally, as NIH Director Francis Collins recently noted in his
testimony to the Subcommittee, researchers are ``aiming to harness the
body's own immune system to fight cancer.'' One such method, known as
chimeric antigen receptor (CAR) cell engineering, extracts T cells
(naturally occurring immune cells) from the blood of a cancer patients
and modifies the cells to produce special proteins on their surface.
With these new engineered features, the T cells are injected back into
the patient, now primed to seek and destroy cancer cells. Preliminary
studies have found that this process may generate responses in as many
as two-thirds of cases in which all other treatment options have
failed. Further, because the cells are derived from the patient, there
is an inherently lower risk of toxicity because the cells are less
likely to attack the host tissue than cells introduced from a foreign
body. Promising results in patients with leukemia prompted Science
magazine to name this its 2013 ``Breakthrough of the Year.''
Hematology advances also help patients with other types of cancers,
heart disease, and stroke. Even modest investments in hematology
research have yielded large dividends for other disciplines. Basic
research on blood has aided physicians who treat patients with heart
disease, strokes, end-stage renal disease, cancer, and AIDS. Blood
thinners effectively treat or prevent blood clots, pulmonary embolism,
and strokes. Death rates from heart attacks are reduced by new forms of
anticoagulation drugs.
Sequestration Threatens Scientific Momentum
ASH is particularly concerned about the impact of continued cuts on
biomedical research supported by the NIH. NIH's ability to continue
current research capacity and encourage promising new areas of science
is, and will be, significantly limited. At a time when we should be
investing more in research to save lives, research funding remains in
serious jeopardy. Trials to find new therapies and cures for millions
of Americans with blood cancers, bleeding disorders, clotting problems,
and genetic diseases are just a few of the important projects that
could be delayed unless NIH continues to receive predictable and
sustained funding.
Additionally, perhaps one of the greatest concerns is the obstacle
these continued cuts will present to the next generation of scientists,
who will see training funds slashed and the possibility of sustaining a
career in research diminished. The Society is especially concerned
about the number of scientists who have abandoned research careers;
continued cuts will exacerbate this exodus, forcing researchers to
abandon potentially life-enhancing research.
Fiscal year 2015 NIH Funding Request
ASH appreciates the welcome and much needed funding increase for
the NIH that Congress provided in the Consolidated Appropriations Act
of 2014. However, this increase did not give back all of the funds cut
by sequestration in fiscal year 2013 nor did it restore the purchasing
power lost over the past decade. ASH supports the Ad Hoc Group for
Medical Research recommendation that NIH receive at least $32 billion
in fiscal year 2015 as the next step toward a multi-year increase in
our Nation's investment in medical research. ASH also urges Congress
and the Administration to work in a bipartisan manner to end
sequestration and the continued cuts to medical research that squander
invaluable scientific opportunities, discourage young scientists,
threaten medical progress and continued improvements in our Nation's
health, and jeopardize our economic future.
Centers for Disease Control and Prevention (CDC) Public Health Response
for Blood Disorders
The Society also recognizes the important role of the Centers for
Disease Control and Prevention (CDC) in preventing and controlling
clotting, bleeding, and other hematologic disorders. Blood disorders--
such as sickle cell disease, anemia, blood clots, and hemophilia--are a
serious public health problem and affect millions of people each year
in the United States, cutting across the boundaries of age, race, sex,
and socioeconomic status. Men, women, and children of all backgrounds
live with the complications associated with these conditions, many of
which are painful and potentially life-threatening.
CDC is uniquely positioned to reduce the public health burden
resulting from blood disorders by contributing to a better
understanding of these conditions and their complications; ensuring
that prevention programs are developed, implemented, and evaluated;
ensuring that information is accessible to consumers and healthcare
providers; and encouraging action to improve the quality of life for
people living with or affected by these conditions. The Society is
concerned that the Division of Blood Disorders was cut by nearly $6
million in the Consolidated Appropriations Act of 2014 and the
President's Budget for fiscal year 2015 did not restore this funding.
ASH respectfully requests that the Division of Blood Disorders be
funded in fiscal year 2015 at $19 million to assure that the programs
funded by the Division for Hemophilia, Thalassemia, Sickle Cell
Disease, and DVT/PE can be maintained. This funding will allow CDC to
improve health outcomes and limit complications to those who are risk
or currently have blood disorders, by promoting a comprehensive care
model; identifying and evaluating effective prevention strategies; and
increasing public and healthcare provider awareness of bleeding and
clotting disorders such as such as hemophilia and thrombosis, and
hemoglobinopathies, including sickle cell disease and thalassemia.
Thank you again for the opportunity to submit testimony. Please
contact Tracy Roades, ASH Legislative Advocacy Manager, at
troades@hematology.org, if you have any questions or need further
information concerning hematology research or ASH's fiscal year 2015
funding request.
______
Prepared Statement of the American Society of Nephrology
The American Society of Nephrology (ASN) is the world's largest
kidney health professional organization in the world, representing
15,000 physicians, other healthcare providers, and scientists, and
committed to advancing research, prevention, and treatment options for
the more than 20 million adults, children, and adolescents with kidney
disease in the United States today. The society requests at least
$2.066 billion for the National Institute of Diabetes and Digestive and
Kidney Diseases (NIDDK) at the National Institutes of Health (NIH). The
society also requests an additional $150 million/year over 10 years for
kidney research above current funding for NIDDK.
ASN believes these are crucial and necessary investments for
preventing illness and maintaining fiscal responsibility. Investing in
research to slow the progression of kidney disease and identify new
therapies will save Medicare spending for the End-Stage Renal Disease
(ESRD) Program in the long run.
In 1972, Congress made a commitment to treat all Americans with
kidney failure through the Medicare ESRD Program--the only health
entitlement program that provides coverage regardless of age or
disability. Today, ESRD patients account for less than 1 percent of the
Medicare population but 7 percent of the Medicare budget. Meanwhile, at
approximately $650 million per year, total Federal funding for kidney
research is equivalent to less than 1 percent of the nearly $77 billion
Medicare spends annually for the care of patients with kidney disease.
Given that the Medicare ESRD Program is unique in that it covers
treatment for all patients with kidney failure regardless of age or
disability, preventing kidney disease and improving therapy--starting
with innovative research at NIDDK--would yield significant savings to
the Centers for Medicare and Medicaid Services.
The vast majority of Federal research leading to advances in the
care and treatment of patients with kidney disease is funded by NIDDK.
Examples of critical discoveries arising from NIDDK-funded research are
numerous.
For instance, investigative studies supported by NIDDK led to a
groundbreaking discovery that helps explain racial and ethnic
disparities that increase risks for kidney disease, which can lead to
earlier detection and treatment. The finding that African Americans
with two variants of the APOL1 gene are likely to progress to kidney
failure faster than other ethnicities paves the way for future research
to unlock better preventive therapies and gene-based cures.
Recent findings from NIDDK's Chronic Renal Insufficiency Cohort
(CRIC) Study led to the discovery that the progression of kidney
disease is associated with less efficient pumping of blood by the
heart. Further research exploring the mechanisms for this development
could lead to new interventions that could slow down the progression of
kidney disease.
Scientists supported by NIDDK have pursued cutting-edge basic,
clinical, and translational research. While ASN fully understands the
difficult economic environment, the society firmly believes that
funding NIDDK is a sound investment to create jobs, support the next
generation of investigators, and ultimately provide quality care that
is less expensive in order to improve the public health of Americans.
Medical research is a major force in the economic health of
communities nationwide: every dollar invested in medical research
generates $2.60 in economic activity. America must continue to
capitalize on previous investments to drive research progress, train
the next generation of scientists, create new jobs, promote economic
growth, and maintain leadership in the global innovation economy--
particularly as other countries increase their investments in
scientific research. Most important, a failure to maintain and
strengthen NIDDK's ability to support the groundbreaking work of
researchers across the country carries a palpable human toll, denying
hope to the millions of patients awaiting the possibility of a
healthier tomorrow.
ASN urges Congress to uphold its longstanding legacy of bipartisan
support for biomedical research. Should you have any questions or wish
to discuss NIDDK or kidney research in more detail, please contact ASN
Manager of Policy and Government Affairs Rachel Meyer at (202) 640-4659
or rmeyer@asn-online.org.
about asn
The American Society of Nephrology (ASN) is a 501(c)(3) non-profit,
tax-exempt organization that leads the fight against kidney disease by
educating the society's 15,000 physicians, scientists, and other
healthcare professionals, sharing new knowledge, advancing research,
and advocating the highest quality care for patients. For more
information, visit ASN's website at www.asn-online.org.
______
Prepared Statement of the American Society of Plant Biologists
On behalf of the American Society of Plant Biologists (ASPB), we
would like to thank the Subcommittee for its support of the National
Institutes of Health (NIH). ASPB and its members strongly believe that
sustained investments in scientific research will be a critical step
toward economic recovery and job creation in our Nation. ASPB supports
the maximum fiscal year 2015 appropriation for NIH and asks that the
Subcommittee Members encourage increased support for plant-related
research within the agency; 25 percent of our medicines originate from
discoveries related to plant natural products, and such research has
contributed in innumerable ways to improving the lives and health of
Americans and people throughout the world.
ASPB is an organization of some 4,500 professional plant biology
researchers, educators, students, and postdoctoral scientists with
members across the Nation and throughout the world. A strong voice for
the global plant science community, our mission--achieved through work
in the realms of research, education, and public policy--is to promote
the growth and development of plant biology, to encourage and
communicate research in plant biology, and to promote the interests and
growth of plant scientists in general.
Plant Biology Research and America's Future
Among many other functions, plants form much of the base of the
food chain upon which all life depends. Importantly, plant research is
also helping make many fundamental contributions in the area of human
health, including that of a sustainable supply and discovery of plant-
derived pharmaceuticals, nutriceuticals, and alternative medicines.
Plant research also contributes to the continued, sustainable,
development of better and more nutritious foods and the understanding
of basic biological principles that underpin improvements in the health
and nutrition of all Americans.
Plant Biology and the National Institutes of Health
Plant science and many of our ASPB member research activities have
enormous positive impacts on the NIH mission to pursue ``fundamental
knowledge about the nature and behavior of living systems and the
application of that knowledge to extend healthy life and reduce the
burdens of illness and disability.'' In general, plant research aims to
improve the overall human condition--be it food, nutrition, medicine or
agriculture--and the benefits of plant science research readily extend
across disciplines. In fact, plants are often the ideal model systems
to advance our ``fundamental knowledge about the nature and behavior of
living systems'' as they provide the context of multi-cellularity while
affording ease of genetic manipulation, a lesser regulatory burden, and
maintenance requirements that are less expensive than those required
for the use of animal systems.
Many fundamental biological components and mechanisms (e.g., cell
division, viral and bacterial invasion, polar growth, DNA methylation
and repair, innate immunity signaling and circadian rhythms) are shared
by both plants and animals. For example, a process known as RNA
interference, which has potential application in the treatment of human
disease, was first discovered in plants. Subsequent research eventually
led to two American scientists, Andrew Fire and Craig Mello, earning
the 2006 Nobel Prize in Physiology or Medicine. More recently
scientists engineered a class of proteins called TALENs capable of
precisely editing genomes to potentially correct mutations that lead to
disease. That these therapeutic proteins are derived from others
initially discovered in a plant pathogen exemplifies the application of
plant biology research to improving human health. These important
discoveries again reflect the fact that some of the most important
biological discoveries applicable to human physiology and medicine can
find their origins in plant-related research endeavors.
Health and Nutrition--Plant biology research is also central to the
application of basic knowledge to ``extend healthy life and reduce the
burdens of illness and disability.'' Without good nutrition, there
cannot be good health. Indeed, a World Health Organization study on
childhood nutrition in developing countries concluded that over 50
percent of child deaths under the age of five could be attributed to
malnutrition's effects in weakening the immune system and exacerbating
common illnesses such as respiratory infections and diarrhea.
Strikingly, most of these deaths were not linked to severe
malnutrition, but chronic nutritional deficiencies brought about by
overreliance on single crops for primary staples. Plant researchers are
working today to address the root cause of this problem by balancing
the nutritional content of major crop plants to provide the full range
of essential micronutrients in plant-based diets.
By contrast to developing countries, obesity, cardiac disease, and
cancer take a striking toll in the developed world. Research to improve
and optimize concentrations of plant compounds known to have, for
example, anti-carcinogenic properties, will hopefully help in reducing
disease incidence rates. Ongoing development of crop varieties with
tailored nutraceutical content is an important contribution that plant
biologists can and are making toward realizing the long-awaited goal of
personalized medicine, especially for preventative medicine.
Drug Discovery--Plants are also fundamentally important as sources
of both extant drugs and drug discovery leads. In fact, 60 percent of
anti-cancer drugs in use within the last decade are of natural product
origin--plants being a significant source. An excellent example of the
importance of plant-based pharmaceuticals is the anti-cancer drug
taxol, which was discovered as an anti-carcinogenic compound from the
bark of the Pacific yew tree through collaborative work involving
scientists at the NIH National Cancer Institute and plant natural
product chemists. Taxol is just one example of the many plant compounds
that will continue to provide a fruitful source of new drug leads.
While the pharmaceutical industry has largely neglected natural
products-based drug discovery in recent years, research support from
NIH offers yet another paradigm. Multidisciplinary teams of plant
biologists, bioinformaticians, and synthetic biologists are being
assembled to develop new tools and methods for natural products
discovery and creation of new pharmaceuticals. We appreciate NIH's
current investment into understanding the biosynthesis of natural
products through transcriptomics and metabolomics of medicinal plants.
The recently released ``Genomes to Natural Products'' funding
opportunity is also to be applauded as a potential avenue for new
plant-related medicinal research, and we strongly encourage the
continuation of these types of investments and other plant-related
initiatives which can help further achievement of the NIH mission.
Conclusion
Although NIH does recognize that plants serve many important roles,
the boundaries of plant-related research are expansive and integrate
seamlessly and synergistically with many different disciplines that are
also highly relevant to NIH. As such, ASPB asks the Subcommittee to
provide the maximum appropriation and direction to NIH to support
additional plant research in order to continue to pioneer new
discoveries and new methods with applicability and relevance in
biomedical research.
Thank you for your consideration of ASPB's testimony. For more
information about ASPB, please see www.aspb.org.
[This statement was submitted by Tyrone C. Spady, Ph.D., Director
of Legislative and Public Affairs American Society of Plant
Biologists.]
______
Prepared Statement of the American Thoracic Society
SUMMARY: FUNDING RECOMMENDATIONS
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
National Institutes of Health................................ 32,000
National Heart, Lung & Blood Institute................... 3,214
National Institute of Allergy & Infectious Disease....... 4,701
National Institute of Environmental Health Sciences...... 717.7
Fogarty International Center............................. 72.7
National Institute of Nursing Research................... 151
Centers for Disease Control and Prevention................... 7,800
National Institute for Occupational Safety & Health...... 292.3
Asthma Programs.......................................... 28
Div. of Tuberculosis Elimination......................... 243
Office on Smoking and Health............................. 250
National Sleep Awareness Roundtable (NSART).............. 1
------------------------------------------------------------------------
The ATS's 15,000 members help prevent and fight respiratory disease
through research, education, patient care and advocacy.
lung disease in america
Diseases of breathing constitute the third leading cause of death
in the U.S., responsible for one of every seven deaths. Diseases
affecting the respiratory (breathing) system include chronic
obstructive pulmonary disease (COPD), lung cancer, tuberculosis,
influenza, sleep disordered breathing, pediatric lung disorders,
occupational lung disease, asthma, and critical illness.
National Institutes of Health
The NIH is the world's leader in groundbreaking biomedical health
research into the prevention, treatment and cure of diseases such as
lung cancer, COPD and tuberculosis. But due to eroded funding, the
success rate for NIH research grants has plummeted to below 13 percent,
which means that more than 85 percent of meritorious research is not
being funded. The implementation of budget sequestration in fiscal year
2013 cut NIH by an additional $1.5 billion, which resulted in the
elimination of at least 1,000 grant opportunities and cuts of up to 10
percent for continuing grants. These cuts will result in the halting of
vital research into diseases affecting millions around the world. We
ask the subcommittee to provide $32 billion in funding for the NIH in
fiscal year 2015.
Despite the rising lung disease burden, lung disease research is
underfunded. In fiscal year 2012, lung disease research represented
just 23.2 percent of the National Heart Lung and Blood Institute's
(NHLBI) budget. Although lung disease is the third leading cause of
death in the U.S., research funding for the disease is a small fraction
of the money invested for the other three leading causes of death. In
order to stem the devastating effects of lung disease, research funding
must continue to grow.
Centers for Disease Control and Prevention
In order to ensure that health promotion and chronic disease
prevention are given top priority in Federal funding, the ATS supports
a funding level for the Centers for Disease Control and Prevention
(CDC) that enables it to carry out its prevention mission, and ensure a
translation of new research into effective State and local public
health programs. We ask that the CDC budget be adjusted to reflect
increased needs in chronic disease prevention, infectious disease
control, including TB control and occupational safety and health
research and training. The ATS recommends a funding level of $7.8
billion for the CDC in fiscal year 2015.
chronic obstuctive pulmonary disease
COPD is the third leading cause of death in the United States and
the third leading cause of death worldwide, yet the disease remains
relatively unknown to most Americans. CDC estimates that 12 million
patients have COPD; an additional 12 million Americans are unaware that
they have this life threatening disease. In 2010, the estimated
economic cost of lung disease in the U.S. was $186 billion, including
$117 billion in direct health expenditures and $69 billion in indirect
morbidity and mortality costs.
The NHLBI is developing a national action plan on COPD, in
coordination with the Centers for Disease Control and Prevention (CDC)
to expand COPD surveillance, development of public health interventions
and research on the disease and increase public awareness of the
disease and we urge Congress to support it. We also urge CDC to include
COPD-based questions to future CDC health surveys, including the
National Health and Nutrition Evaluation Survey (NHANES) and the
National Health Information Survey (NHIS).
tobacco control
Cigarette smoking is the leading preventable cause of death in the
U.S., responsible for one in five deaths annually. The ATS is pleased
that the Department of Health and Human Services has made tobacco use
prevention a key priority. The CDC's Office of Smoking and Health
coordinates public health efforts to reduce tobacco use. In order to
significantly reduce tobacco use within 5 years, as recommended by the
subcommittee in fiscal year 2010, the ATS recommends a total funding
level of $250 million for the Office of Smoking and Health in fiscal
year 2015.
asthma
Asthma is a significant public health problem in the United States.
Approximately 25 million Americans currently have asthma. In 2010,
3,388 Americans died as a result of asthma exacerbations. Asthma is the
third leading cause of hospitalization among children under the age of
15 and is a leading cause of school absences from chronic disease. The
disease costs our healthcare system over $50.1 billion per year.
African Americans have the highest asthma prevalence of any racial/
ethnic group and the age-adjusted death rate for asthma in this
population is three times the rate in whites. A study published in the
American Journal of Respiratory Critical Care in 2012 found that for
every dollar invested in asthma interventions, there was a $36 benefit.
We ask that the subcommittee's appropriations request for fiscal year
2015 that funding for CDC's National Asthma Control Program be
maintained at a funding level of at least $28 million.
sleep
Several research studies demonstrate that sleep-disordered
breathing and sleep-related illnesses affect an estimated 50-70 million
Americans. The public health impact of sleep illnesses and sleep
disordered breathing is still being determined, but is known to include
increased mortality, traffic accidents, cardiovascular disease,
obesity, mental health disorders, and other sleep-related
comorbidities. The ATS recommends a funding level of $1 million in
fiscal year 15 to support activities related to sleep and sleep
disorders at the CDC, including for the National Sleep Awareness
Roundtable (NSART), surveillance activities, and public educational
activities. The ATS also recommends an increase of funding for research
on sleep disorders at the Nation Center for Sleep Disordered Research
(NCSDR) at the NHLBI.
tuberculosis
Tuberculosis (TB) is the second leading global infectious disease
killer, claiming 1.3 million lives each year. In the U.S., every State
reports cases of TB annually. Drug-resistant TB poses a particular
challenge to domestic TB control due to the high costs of treatment and
intensive healthcare resources required. Treatment costs for multidrug-
resistant (MDR) TB range from $100,000 to $300,000. The global TB
pandemic and spread of drug resistant TB present a persistent public
health threat to the U.S.
The Comprehensive Tuberculosis Elimination Act (CTEA, Public Law
110-392), enacted in 2008, reauthorized programs at CDC with the goal
of putting the U.S. back on the path to eliminating TB. The ATS,
recommends a funding level of $243 million in fiscal year 2015 for
CDC's Division of TB Elimination, as authorized under the CTEA, and
encourages the NIH to expand efforts to develop new tools to reduce the
rising global TB burden.
pediatric lung disease
The ATS is pleased to report that infant death rates for various
lung diseases have declined for the past 10 years. In 2009, of the 10
leading causes of infant mortality, 4 were lung diseases or had a lung
disease component. Many of the precursors of adult respiratory disease
start in childhood. Many children with respiratory illness grow into
adults with COPD. It is estimated that 7.1 million children suffer from
asthma. While some children appear to outgrow their asthma when they
reach adulthood, 75 percent will require life-long treatment and
monitoring of their condition. The ATS encourages the NHLBI to continue
with its research efforts to study lung development and pediatric lung
diseases.
critical illness
The burden associated with the provision of care to critically ill
patients is enormous, and is anticipated to increase significantly as
the population ages. Approximately 200,000 people in the United States
require hospitalization in an intensive care unit because they develop
a form of pulmonary disease called Acute Lung Injury. Despite the best
available treatments, 75,000 of these individuals die each year from
this disease. This is the approximately the same number of deaths each
year due to breast cancer, colon cancer, and prostate cancer combined.
Investigation into diagnosis, treatment and outcomes in critically ill
patients should be a priority, and the NIH should be encouraged and
funded to coordinate investigation in this area in order to meet this
growing national imperative.
fogarty international center
The Fogarty International Center (FIC) provides training grants to
U.S. universities to teach AIDS treatment and research techniques to
international physicians and researchers. Because of the link between
AIDS and TB infection, FIC has created supplemental TB training grants
for these institutions to train international health professionals in
TB treatment and research. The ATS recommends Congress provide $72.8
million for FIC in fiscal year 2015, to allow expansion of the TB
training grant program from a supplemental grant to an open competition
grant.
researching and preventing occupational lung disease
As Congress considers funding priorities for fiscal year 2015, the
ATS urges the subcommittee to provide at least level funding for the
National Institute for Occupational Safety and Health (NIOSH). NIOSH,
within the Centers for Disease Control and Prevention (CDC), is the
primary Federal agency responsible for conducting research and making
recommendations for the prevention of work-related illness and injury.
The ATS appreciates the opportunity to submit this statement to the
subcommittee.
[This statement was submitted by Thomas Ferkol, MD, President,
American Thoracic Society.]
______
Prepared Statement of the Americans for Nursing Shortage Relief
The organizations of the ANSR Alliance greatly appreciate the
opportunity to submit written testimony recommending $251 million in
fiscal year 2015 for the Title VIII Nursing Workforce Development
Programs at the Health Resources and Services Administration (HRSA) and
$20 million for the Nurse Managed Health Clinics as authorized under
Title III of the Public Health Service Act. We represent a diverse
cross-section of healthcare and other related organizations, healthcare
providers, and supporters of nursing issues (http://
www.ansralliance.org/Members.html) that have united to address the
national nursing shortage. ANSR stands ready to work with Congress to
advance programs and policy that will ensure our Nation has a
sufficient and adequately prepared nursing workforce to provide quality
care to all well into the 21st century.
The Nursing Shortage
Nursing is the largest healthcare profession in the United States
and work in a variety of settings, including primary care, public
health, long-term care, surgical care facilities, schools, and
hospitals. In the Bureau of Labor Statistics (BLS) Employment
Projections for 2012-2022, the total employment of registered nurses
(RNs) and advanced practice registered nurses (APRNs) will increase by
574,400 jobs. With upcoming RN retirements in the mix, the Nation will
need to produce 1.13 million new RNs by 2022 to fill those jobs.
Because of the retirements, the projected number of RNs needed to fully
staff healthcare facilities is virtually double the number of increased
jobs due to expanded demand from new patients coupled with the aging
baby boomer population wanting healthcare services. More new RNs are
graduating from nursing programs than had been observed in the early
2000's but not sufficient numbers to make up the difference over the
long-term. The Title VIII Nursing Workforce Education Programs will
help fill these vacancies by supporting training programs designed to
meet these healthcare needs.
The Title VIII Nursing Workforce and Education programs provide
training for entry-level and advanced degree nurses to improve the
access to, and the quality of, healthcare in underserved areas. These
programs provide the largest source of Federal funding for nursing
education, providing loans, scholarships, traineeships, and
programmatic support that, between fiscal year 2005 and 2010, supported
over 400,000 nurses and nursing students as well as numerous academic
nursing institutions and healthcare facilities.
The Desperate Need for Nurse Faculty
Nursing vacancies exist throughout the entire healthcare system,
including long-term care, home care and public health. Government
estimates indicate that this situation only promises to worsen due to
an insufficient supply of individuals matriculating in nursing schools,
an aging existing workforce, and the inadequate availability of nursing
faculty to educate and train the next generation of nurses. At the
exact same time that the nursing shortage is expected to worsen, the
baby boom generation is aging and the number of individuals with
serious, life-threatening, and chronic conditions requiring nursing
care will increase.
Each year, nursing schools turn away tens of thousands of qualified
applications at all degree levels due to an insufficient number of
faculty, clinical sites, classroom space, clinical preceptors, and
budget constraints. Securing and retaining adequate numbers of faculty
is essential to ensure that all individuals interested in--and
qualified for--nursing school can matriculate in the year that they are
accepted.
ANSR supports the need for sustained attention on the efficacy and
performance of existing and proposed programs to improve nursing
practices and strengthen the nursing workforce. The support of research
and evaluation studies that test models of nursing practice and
workforce development is integral to advancing healthcare for all in
America. Investments in research and evaluation studies have a direct
effect on the caliber of nursing care. Our collective goal of improving
the quality of patient care, reducing costs, and efficiently delivering
appropriate healthcare to those in need is served best by aggressive
nursing research and performance and impact evaluation at the program
level.
The Nursing Supply Impacts the Nation's Health and Economic Safety
The demand for primary care services in the US is expected to
increase over the next few years, particularly with the aging and
growth of the population. One study projects that by the year 2019, the
demand for primary care in the United States will increase by between
15 million and 25 million visits per year. HRSA estimates that more
than 35.2 million people living within the 5,870 Health Professional
Shortage Areas nationwide do not currently receive adequate primary
care services. Research suggests that nurses and other health
professionals are trained to and already do deliver many primary care
services and may therefore be able to help increase access to primary
care, particularly in underserved areas.
ANSR applauds the subcommittee's bipartisan efforts to recognize
that a strong nursing workforce is essential to a health policy that
provides high-value care for every dollar invested in capacity building
for a 21st century nurse workforce. For 50 years, the Title VIII
Nursing Workforce Development Programs have responded to the Nation's
evolving workforce needs by providing education and training
opportunities to nurses. These programs are the only Federal programs
focused on filling gaps in the supply of nurses not met by traditional
market forces, as well as producing a workforce prepared to care for
the Nation's increasingly diverse and aging population. Numerous
studies have demonstrated that the Title VIII programs graduate more
minority and disadvantaged students more likely to serve in community
health centers as well as rural and underserved areas. In a difficult
economy, the Title VIII Nursing Workforce Education Programs help
schools offer scholarships and affordable loans to nursing students,
making such educational opportunities available to aspiring nurses of
all backgrounds. By guiding job seekers to high-demand nursing jobs,
the programs fulfill both their individual career goals and a
community's health needs.
Summary
HRSA's Title VIII Nursing Workforce Education programs contribute
to a sufficient nursing workforce to meet the demands of a highly
diverse and aging population is an essential component to improving the
health status of the Nation and reducing healthcare costs. While the
ANSR Alliance understands the immense fiscal pressures facing the
Nation, we respectfully urge support for $251 million in funding for
Nursing Workforce Development Programs under Title VIII of the Public
Health Service Act at HRSA and $20 million for the Nurse Managed Health
Clinics under Title III of the Public Health Service Act in fiscal year
2015. We look forward to working with the Subcommittee to prioritize
the Title VIII programs in fiscal year 2015 and the future.
ansr alliance co-chairs
Christine Murphy, ANSR Alliance Co-Chair
Senior Public Policy Specialist
National League for Nursing
Wade Delk, ANSR Alliance Co-Chair
Government Affairs Director
American Society for Pain Management Nursing & International Nurses
Society on Addictions
list of ansr member organizations:
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Academy of Nurse Practitioners
American Academy of Nursing
American Association of Nurse Anesthetists
American Association of Nurse Assessment Coordination
American Association of Occupational Health Nurses
American College of Nurse-Midwives
American Organization of Nurse Executives
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
American Society of Plastic Surgical Nurses
Association for Radiologic & Imaging Nursing
Association of Pediatric Hematology/Oncology Nurses
Association of State and Territorial Directors of Nursing
Association of Women's Health, Obstetric & Neonatal Nurses
Citizen Advocacy Center
Dermatology Nurses' Association
Developmental Disabilities Nurses Association
Emergency Nurses Association
Infusion Nurses Society
International Association of Forensic Nurses
International Nurses Society on Addictions
International Society of Nurses in Genetics, Inc.
Legislative Coalition of Virginia Nurses
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Neonatal Nurses
National Association of Neonatal Nurse Practitioners
National Association of Nurse Massage Therapists
National Association of Nurse Practitioners in Women's Health
National Association of Orthopedic Nurses
National Association of Registered Nurse First Assistants
National Association of School Nurses
National Black Nurses Association
National Council of State Boards of Nursing
National Council of Women's Organizations
National Gerontological Nursing Association
National League for Nursing
National Nursing Centers Consortium
National Nursing Staff Development Organization
National Organization for Associate Degree Nursing
National Student Nurses' Association, Inc.
Nurses Organization of Veterans Affairs
Pediatric Endocrinology Nursing Society
Preventive Cardiovascular Nurses Association
RN First Assistants Policy & Advocacy Coalition
Society of Gastroenterology Nurses and Associates, Inc.
Society of Pediatric Nurses
Society of Trauma Nurses
Women's Research & Education Institute
Wound, Ostomy and Continence Nurses Society
______
Prepared Statement of the Animal Protection of New Mexico and Animal
Protection Voters
On behalf of the board, staff, members and supporters of Animal
Protection of New Mexico (APNM) and Animal Protection Voters (APV), we
sincerely appreciate the opportunity to provide testimony on our top
NIH funding priority for the House Labor, Health and Human Services,
Education and Related Agencies Appropriations Subcommittee in fiscal
year 2015.
capacity for federally-owned chimpanzees retired by the national
institutes of health
APNM and APV request NIH be given authority to use $5 million of
funds appropriated in this and subsequent appropriations bills for
extramural construction and renovation within the National Chimpanzee
Sanctuary System.
In 2013, NIH announced their plan to retire hundreds of government
owned chimpanzees to sanctuary. This decision followed years of
scientific review that determined chimpanzees are not necessary for
research to advance human health along with broad public outcry over
the ethics of holding chimpanzees in labs. Additional sanctuary
construction is needed to enable NIH to move forward with their plan to
retire the vast majority of government owned chimpanzees. Even taking
into account upfront construction expenditures, the sooner the
construction is completed and the chimpanzees are moved to sanctuary,
the more the government will save over the lifetimes of the
chimpanzees--which can be 60 years or more.
Detailed information on the request follows.
Background information
In June of 2010, the National Institutes of Health proposed a plan
to move 202 aging, sick chimpanzees from a facility New Mexico where
they had not been used for invasive research for years to a laboratory
in Texas for further research. Intense public scrutiny over the animal
cruelty issues and taxpayer waste of this plan was bolstered by
involvement from New Mexico Governor Bill Richardson, Dr. Jane Goodall,
and many more. In December 2010 U.S. Senators Tom Udall, Tom Harkin,
and Jeff Bingaman requested an independent study from the National
Academy of Sciences on whether chimpanzees are necessary as invasive
research subjects.
The December 2011 Institute of Medicine study found that
chimpanzees are not necessary for the vast majority of research and
noted the serious ethical objections raised by keeping chimps in
research labs. Immediately following the announcement of the IOM study
results, NIH accepted the findings and assembled a panel of experts to
advise them on the best way to implement the IOM findings. NIH accepted
nearly all of the expert panel's recommendations in their final
decision. In June of 2013, the National Institutes of Health announced
their plan to retire all but 50 government-owned chimpanzees to
sanctuary, significantly curtail the use of chimps in NIH funded
studies and not to revitalize breeding of chimpanzees for research.
NIH had already begun the transfer of the 110 government owned
chimpanzees at the New Iberia Research Center in Louisiana to Chimp
Haven (the National Chimpanzee Sanctuary), also located in Louisiana.
This transfer is on schedule to be completed by the end of fiscal year
2014. At that point, approximately 350 government-owned chimpanzees
will remain in laboratories--300 of whom are slated for retirement to
sanctuary per NIH's plan.
In late November of 2013, the President signed into law amendments
to the Chimpanzee Health Improvement Maintenance and Protection (CHIMP
Act) which continued funding for the care, maintenance and
transportation of federally owned chimpanzees over the next 5 years.
These amendments have enabled NIH to provide funds for basic care for
chimpanzees the agency already approved into sanctuary and also set the
stage for NIH to move forward with their plan to retire hundreds more
chimpanzees.
Costs in laboratories vs. sanctuary
Accredited sanctuaries provide the highest welfare standards for
chimps at a lower cost to taxpayers than housing chimpanzees in
research laboratories (see attached chart). It is estimated that
transferring the 300 government-owned chimpanzees who are slated for
retirement from the laboratories where they are currently housed to the
national sanctuary will save taxpayers $1.7 million to $2.7 million per
year in care and maintenance costs.
Construction to house more chimpanzees in sanctuary will require an
upfront expenditure. However, due to the lower per diem cost in
sanctuary, retiring chimpanzees to sanctuary will still yield a
significant savings to taxpayers. The sooner construction is completed
and the chimpanzees are moved to sanctuary, the more the taxpayers will
save.
We respectfully request the subcommittee to consider the following
language for inclusion in the appropriations bill:
Of the funds appropriated to NIH, $5,000,000 shall be for grants or
contracts for construction, renovation, or repair of the sanctuary
system established by Section 404K of the Public Health Service Act.
Estimated Costs Related to Care and Maintenance of Government Owned
Chimpanzees:
Government Owned Chimpanzees in Research Facilities and Research Reserve Facilities
----------------------------------------------------------------------------------------------------------------
Number of NIH cost, $/
Facility chimpanzees NIH cost, $M/year chimpanzee/day
----------------------------------------------------------------------------------------------------------------
New Iberia Research Center.......................... \1,2\ 59 \3\ 1.01 \4\ 46.7
Keeling Center for Comparative Medicine and Research \2\147 \3\ 2.44 45.4
Keeling Center for Comparative Medicine and \2\ 16 \2\ 0.4 68.8
Research, DVR grant................................
Southwest National Primate Research Center, U42 \2\ 22 \3\ 0.65 80.9
grant \5\..........................................
Alamogordo Primate Facility......................... \2\ 162 \2\ 3.60 61.3
Totals.......................................... 406 8.10 Average: 54.7
----------------------------------------------------------------------------------------------------------------
Government Owned Chimpanzees in Sanctuary
----------------------------------------------------------------------------------------------------------------
Number of NIH cost, $/
Facility chimpanzees NIH cost, $M/year animal/day,
----------------------------------------------------------------------------------------------------------------
Chimp Haven............................................ \6\ 118-153 \7\ 1.7 30-39
----------------------------------------------------------------------------------------------------------------
\1\ The remaining 59 chimpanzees at New Iberia Research Center are scheduled to be moved to Chimp Haven by the
end of fiscal year 2014
\2\ Based on information available on NIH website regarding chimpanzee maintenance costs for fiscal year 2014
\3\ Based on data available in NIH Research Portfolio Online Reporting Tools (RePORT) for fiscal year 2014
\4\ Figure expected to increase significantly as chimpanzees move to Chimp Haven and funds are spread over fewer
chimpanzees
\5\ In addition to this grant, NIH also supports an additional 91 chimpanzees at the facility. These chimpanzees
are owned by the laboratory and are not under the control of NIH.
\6\ Fifty chimpanzees from New Iberia Research Center were transferred to Chimp Haven during this contract year.
\7\ Unlike the other facilities, Chimp Haven has a cost reimbursement contract in which they are reimbursed for
costs incurred. This number represents actual costs billed to NIH over the most recently completed contract
year (06/30/2012--06/29/2013)
We appreciate the opportunity to share this testimony with the
Labor, Health and Human Services, Education and Related Agencies
Appropriations Act for fiscal year 2015. We hope the Committee will be
able to accommodate this request. Thank you for your consideration.
______
Prepared Statement of the Association of American Cancer Institutes
The Association of American Cancer Institutes (AACI), representing
93 of the Nation's premier academic and free-standing cancer centers,
appreciates the opportunity to submit this statement for consideration
by the subcommittee. AACI submits this request for the Department of
Health and Human Services budget for the National Institutes of Health
(NIH) in the amount of $32 billion for fiscal year 2015.
AACI thanks Congress for its long-standing commitment to ensuring
quality care for cancer patients, as well as for providing researchers
with the resources that they need to develop better cancer treatments
and, ultimately, to find cures for this deadly disease. The partnership
between the Federal Government and our Nation's cancer centers is
mutually beneficial, and cancer centers continue to make strides in
biomedical research thanks to a partnership with the Federal
Government. Without such support, research projects with the potential
to discover breakthrough therapies would not be possible.
The President's fiscal year 2015 budget proposes $30.2 billion for
the NIH, an increase of $200 million (0.7 percent) over the fiscal year
2014 level. This amount includes $4.931 billion for the National Cancer
Institute (NCI), a $7.5 million increase over fiscal year 2014 (0.2
percent). Though we appreciate the president's support, NIH and NCI
continue to endure a lag in funding. The fiscal year 2015 proposal
falls far short of the inflation rate of 2.9 percent, a figure that NIH
projected last year for the Biomedical Research and Development Price
Index (BRDPI) for fiscal year 2015. AACI joins with our colleagues in
the biomedical research community in recommending that the subcommittee
recognize NIH as a critical national priority by providing at least $32
billion in funding in the fiscal year 2015 Labor-HHS-Education
Appropriations bill, including an equivalent percentage increase in
funding for NCI. This funding level represents the minimum investment
necessary to avoid further loss of promising research.
cancer centers must be supported in order to move research forward
America's standing in research and scientific discovery is
threatened with each dollar slashed from the NIH budget. The budgetary
pain in fiscal year 2014 has been less intense than in recent years but
still remains for cancer centers striving both to keep gifted
scientists at their institutions and to resume halted research projects
due to sequestration. For some labs, recovery is nowhere in sight. Many
have closed their doors, while some scientists have taken early
retirement or simply left the field. Even some well-established labs
claim they will never recover from the damage caused by sequestration.
With cancer centers challenged to provide infrastructure resources
necessary to support researchers, the failure to keep pace with the
biomedical inflation rate will limit AACI members' ability to provide
well-functioning shared resources to investigators who depend on them
to complete their research. For most academic cancer centers, the
majority of NCI grant funds are used to sustain shared resources that
are essential to basic, translational, clinical and population cancer
research, or to provide matching dollars which allow departments to
recruit new cancer researchers to a university and support them until
they receive their first grants. Center infrastructure is expensive and
it is not clear where cancer centers would acquire alternative funding
if NCI grants for these efforts continue to dwindle.
AACI cancer centers are at the forefront of the national effort to
eradicate cancer. The cancer centers that AACI represents house more
than 20,000 scientific, clinical and public health investigators who
work collaboratively to translate promising research findings into new
approaches to prevent and treat cancer. Making progress against cancer
is complex and time-intensive. However, the pace of discovery and
translation of novel basic research to new therapies could be quickened
if researchers could count on an appropriate and predictable investment
in Federal cancer funding. As research costs and patient need increase,
cancer centers continue to be highly dependent on Federal cancer center
grants.
cancer centers are pioneers in research
The negative effects of diminished biomedical research funding
reach beyond the lab as AACI cancer center directors have vocalized
their concerns. The impact of flat funding to the NIH continues to
disturb advances in biomedical research and is of paramount concern to
cancer center leaders.
While AACI President Michelle M. Le Beau, PhD, director of the
University of Chicago Comprehensive Cancer Center, applauded the
president's budget proposal, she asked that Congress build upon that
budget. Dr. Le Beau has said that at a time when cancer centers
continue to address the losses sustained due to budget sequestration,
research institutions rely on robust aid from their partnership with
the Federal Government. She said, ``Cancer centers have served as
pioneers in biomedical research, improving patient care and gaining a
deeper understanding of the molecular basis of cancer through research.
Advances in science are within reach, but without sufficient funding at
the NIH and ultimately, the NCI, such progress in research will move at
a slower pace.''
Speaking at a meeting of the AACI Government Relations Forum in
Houston, TX, University of Texas MD Anderson Cancer Center president
Ronald DePinho, MD, echoed Dr. Le Beau's concerns. Dr. DePinho
underscored the need for increased Federal funding for cancer research,
noting that cancer incidence in the U.S. is projected to increase 45
percent between today and 2030. Dr. DePinho has acknowledged that the
major solutions for patients will come from scientific innovations that
will lead to transformation in cancer prevention, early detection and
definitive cures. He said that academic medical centers are the engines
for such discoveries. Dr. DePinho stressed that it is ``critical that
we vigorously support these national treasures to deal with the
onslaught of people who will need cancer services.''
University of New Mexico Cancer Center researchers, physicians, and
staff work tirelessly to provide vital patient care and breakthrough
cancer technology to a richly diverse and widely dispersed population.
Cancer center director and CEO Cheryl Lynn Willman, MD is dedicated to
ensuring all patients who enter UNM Cancer Center receive unsurpassed
care, yet she is troubled by worries that not everyone in New Mexico
has the ability and means to seek care at the NCI-designated center.
While Willman and her team at UNM Cancer Center devote their time,
effort, and hard work to bringing the most advanced cancer treatments
available to the public, providing all potential patients with access
to care is not achieved without high costs. Without sustained and
stable NIH funding UNM Cancer Center and other centers across the
country will struggle to uphold their devoted mission in cancer care
and research to the people of New Mexico.
Robert S. DiPaola, MD, director of Rutgers Cancer Institute of New
Jersey, knows the strides that can be made within cancer research due
to increased NIH funding. Recently, Rutgers was awarded a competitive
grant by the NCI to support their precision experimental therapeutics
endeavor. Dr. DiPaola was proud to announce their collaboration with
investigators from the University of Wisconsin Carbone Cancer Center as
well as with a network of cancer centers. Though Dr. DiPaola and his
team are grateful for the NCI funding that has made this work possible,
they are increasingly aware that without adequate increases to NIH
funding, the future of cancer research collaboration could suffer. He
asserted that, ``Ensuring that NIH acquires an increase at least
relative to the inflation rate of 2.9 percent will help to keep the
progress we are making in cancer research nationwide moving in the
right direction.''
Samir N. Khleif, MD, director of GRU Cancer Center at Georgia
Regents University, testified before the appropriations subcommittee on
March 25, noting that decades of sustained strong investment in NIH and
NCI have sparked remarkable progress in cancer research and treatment.
Dr. Khleif asked for increased funding at the NIH and the NCI in order
to ``keep our best and brightest minds focused on developing the
biomedical research breakthroughs that save lives.'' He requested that
support for NIH not falter in order for the U.S. to maintain its global
edge in scientific discovery and innovation and maintain its progress
in reducing the burden of cancer and other diseases.
AACI President-Elect George Weiner, MD, director of the Holden
Comprehensive Cancer Center at the University of Iowa, agreed with Dr.
Khleif's testimony. Dr. Weiner's greatest concern stems from the
decrease in funding for the NIH and the NCI and the impact reduced
Federal funding will have on young scientists and he has blogged about
scientific and budgetary concerns. Dr. Weiner fears young scientists
might not chose to conduct their research in the U.S. in the future,
instead opting to go overseas as U.S. support for innovation has been
flat or dropped and other countries begin to make progress. Dr. Weiner
knows that the U.S. remains the world leader in biomedical research,
but feels that ``ongoing success will be dependent on outstanding
physicians and scientists, born here and abroad, having the
collaborative culture, resources and infrastructure needed to
accelerate progress toward our shared mission of reducing the burden of
cancer.'' Dr. Weiner stated that providing these tools will have a
positive impact on our Nation's ability to care for patients, our
ability to conduct research, and our economy. Dr. Weiner stressed the
need to continue to emphasize the importance of investing in innovation
through education and research. He maintained that a commitment to
investing in the NIH and the NCI is vital to the successes achieved
through science.
cancer research is improving america's health
The broad portfolio of research supported by NIH and NCI is
essential for improving our basic understanding of diseases and has
paid off considerably in terms of improving Americans' health. The 5-
year relative survival rate for all cancers diagnosed between 2002 and
2008 is 68 percent, up from 49 percent in 1975-1977. In addition,
cancer death rates have dropped 11.4 percent among women and 19.2
percent among men over the past 15 years.\1\ The improvement in
survival reflects both progress in diagnosing certain cancers at an
earlier stage and better treatment.
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\1\ American Cancer Society. Facts and Figures, 2014. http://
www.cancer.org/research/cancerfactsstatistics/cancerfactsfigures2014/.
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Despite that success, cancer remains the second leading cause of
death in the U.S., with almost 1,600 deaths per day. More than 1.6
million new cancer cases will be discovered in 2014 and over 580,000
cancer deaths are expected.\2\ NCI estimates that 41 percent of
individuals born today will receive a cancer diagnosis at some point in
their lifetime.\3\
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\2\ American Cancer Society. Facts and Figures.
\3\ Cancer Trends Progress Report--2011/2012 Update, National
Cancer Institute, NIH, DHHS, Bethesda, MD, August 2012, http://
progressreport.cancer.gov.
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conclusion
NIH estimates that the overall costs of cancer in 2008 were $201.5
billion: $77.4 billion for direct medical costs (total of all health
expenditures) and $124 billion for indirect mortality costs (cost of
lost productivity due to premature death).\4\ The cost of cancer
continues to rise, but the investment in cancer research will one day
eliminate such economic burdens on Americans and the cancer center
researchers who work tirelessly to find a cure for this deadly disease.
Failure to keep pace with the biomedical rate of inflation will only
hinder our Nation's cancer center researchers from grasping future
knowledge that will aid in the prevention, detection and treatment of
cancer.
---------------------------------------------------------------------------
\4\ American Cancer Society. Facts and Figures.
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As Congress makes difficult appropriations decisions for fiscal
year 2015 and beyond, AACI asks that it recall that the Nation's
financial support of NIH and NCI has paid dividends by introducing
innovative therapies for cancers that years ago cut short far too many
American lives. The future of scientific discovery in cancer research
is in the hands of the scientists whose research is conducted in labs
across the country. NIH's full support of NCI-designated centers and
their programs remains a top priority for our Nation's research
institutions and we ask that Congress aid our Nation's cancer centers
in their goal to eradicate cancer.
[This statement was submitted by Barbara Duffy Stewart, MPH,
Executive Director, Association of American Cancer Institutes.]
______
Prepared Statement of the Association of American Medical Colleges
The Association of American Medical Colleges (AAMC) is a not-for-
profit association representing all 141 accredited U.S. and 17
accredited Canadian medical schools; nearly 400 major teaching
hospitals and health systems; and nearly 90 academic and scientific
societies. Through these institutions and organizations, the AAMC
represents 128,000 faculty members, 75,000 medical students, and
110,000 resident physicians. The AAMC requests the following for
Federal priorities essential in assisting medical schools and teaching
hospitals to fulfill their missions of education, research, and patient
care: at least $32 billion for the National Institutes of Health (NIH);
$375 million for the Agency for Healthcare Research and Quality (AHRQ);
$520 million for the Title VII and VIII health professions workforce
programs the Health Resources and Services Administration (HRSA)'s
Bureau of Health Professions; and student aid through the Department of
Education and HRSA's National Health Service Corps. The AAMC
appreciates the Subcommittee's longstanding, bipartisan efforts to
strengthen these programs.
National Institutes of Health--Congress's long-standing bipartisan
support for medical research through the NIH has created a scientific
enterprise that is the envy of the world and has contributed greatly to
improving the health and well-being of all Americans. The foundation of
scientific knowledge built through NIH-funded research drives medical
innovation that improves health through new and better diagnostics,
improved prevention strategies, and more effective treatments.
Nearly 84 percent of NIH research funding is awarded to more than
2,500 research institutions in every state. At least half of this
funding supports life-saving research at America's medical schools and
teaching hospitals, where scientists, clinicians, fellows, residents,
medical students, and trainees work side-by-side to improve the lives
of Americans through research. This successful partnership between the
Federal Government and academic medicine not only lays the foundation
for improved health and quality of life, it also strengthens the
Nation's long-term economy.
The Consolidated Appropriations Act of 2014 included a welcome and
much needed increase for NIH. However, this increase did not restore
the funding cut from sequestration in fiscal year 2013 or the
purchasing power lost over the past decade. The AAMC hopes fiscal year
2014 represents a first step toward restoring our Nation's preeminence
in medical research. The AAMC supports the Ad Hoc Group for Medical
Research recommendation that NIH receive at least $32 billion in fiscal
year 2015 as the next step toward a multi-year increase in our Nation's
investment in medical research. The AAMC also urges Congress and the
Administration to work in a bipartisan manner to end sequestration and
the continued cuts to medical research that squander invaluable
scientific opportunities, discourage young scientists, threaten medical
progress and continued improvements in our Nation's health, and
jeopardize our economic future.
The AAMC thanks the Subcommittee for its efforts to retain the
limit on salaries that can be drawn from NIH extramural awards at
Executive Level II of the Federal Executive Pay Scale. Medical schools'
and teaching hospitals' discretionary funds from clinical revenues and
other sources have become increasingly constrained and less available
to invest in research. If institutions and departments divert funds to
compensate for a reduction in the salary limit, they have less funding
for critical activities such as bridge funding to investigators between
grants and start-up packages to young investigators to launch their
research programs. A lower salary cap also will disproportionately
affect physician investigators, who will be forced to make up salaries
from clinical revenues, thus leaving less time for research. This may
serve as a deterrent to their recruitment into research careers. The
AAMC urges the Subcommittee to continue its efforts to retain the limit
at Executive Level II.
Agency for Healthcare Research and Quality--Complementing the
medical research supported by NIH, AHRQ sponsors health services
research designed to improve the quality of healthcare, decrease
healthcare costs, and provide access to essential healthcare services
by translating research into measurable improvements in the healthcare
system. The AAMC firmly believes in the value of health services
research as the Nation continues to strive to provide high-quality,
evidence-based, efficient, and cost-effective healthcare to all of its
citizens. The AAMC joins the Friends of AHRQ in recommending $375
million in base discretionary funding for the agency in fiscal year
2015.
As the only Federal agency with the sole purpose of generating
evidence to make healthcare safer; higher quality; and more accessible,
equitable, and affordable, AHRQ also works to ensure such evidence is
available across the continuum of healthcare stakeholders, from
patients to payers to providers. These research findings will better
guide and enhance consumer and clinical decisionmaking, provide
improved healthcare services, and promote efficiency in the
organization of public and private systems of healthcare delivery.
Health Professions Funding--HRSA's Title VII health professions and
Title VIII nursing education programs are the only Federal programs
designed to improve the supply, distribution, and diversity of the
Nation's primary care workforce. Through loans, loan guarantees, and
scholarships to students, and grants and contracts to academic
institutions and non-profit organizations, the Title VII and Title VIII
programs fill the gaps in the supply of health professionals not met by
traditional market forces.
Titles VII and VIII are structured to allow grantees to test
educational innovations, respond to changing delivery systems and
models of care, and address timely topics in their communities. By
assessing the needs of the communities they serve and emphasizing
interprofessional education and training, Title VII and VIII programs
bring together knowledge and skills across disciplines to provide
effective, efficient and coordinated care. Further, numerous studies
demonstrate that the programs graduate more minority and disadvantaged
students and prepare providers that are more likely to serve in
Community Health Centers (CHC) and the National Health Service Corps
(NHSC).
The AAMC joins the Health Professions and Nursing Education
Coalition (HPNEC) in recommending $520 million for these important
workforce programs in fiscal year 2015. This funding level is necessary
to ensure continuation of all Title VII and Title VIII programs while
also supporting promising initiatives such as the Pediatric
Subspecialty Loan Repayment program, the Clinical Training in
Interprofessional Practice program, the Rural Physician Training
Grants, and other efforts to bolster the workforce.
The AAMC strongly objects to the Administration's proposal to
eliminate the Area Health Education Centers (AHEC), which, in 2012
alone, trained more than 20,000 health professions students in
community-based settings, and the Health Careers Opportunity Program
(HCOP), which research shows has helped students from disadvantaged
backgrounds achieve higher grade point averages and matriculate into
health professions programs. Continued support for these and the full
spectrum of Title VII and programs is essential to prepare our next
generation of medical professionals to adapt to the evolving healthcare
needs of the changing population.
In addition to funding for Title VII and Title VIII, HRSA's Bureau
of Health Professions also supports the Children's Hospitals Graduate
Medical Education (CHGME) program. This program provides critical
Federal graduate medical education support for children's hospitals to
prepare the future primary care and specialty care workforce for our
Nation's children. At a time when the Nation faces a critical physician
shortage, the AAMC has serious concerns about the proposed elimination
of the CHGME program in the president's budget. We strongly support
full funding for the Children's Hospitals Graduate Medical Education
program at $300 million in fiscal year 2015.
Student Aid and the National Health Service Corps (NHSC)--The AAMC
urges the committee to sustain student loan and repayment programs for
graduate and professional students at the Department of Education. The
average graduating debt of medical students is currently $175,000, and
typical repayment can range from $326,000 to $492,000.
The AAMC urges Congress to reauthorize the National Health Service
Corps (NHSC) Fund, created under the Affordable Care Act (ACA, Public
Law 111-142 and Public Law 111-152) and set to expire at the end of
fiscal year 2015. In the absence of continued mandatory funding, the
committee must address the NHSC funding shortfall in the already
strained Labor-HHS spending bill. To date, the steady, sustained, and
certain growth established by this mandatory funding for the NHSC has
resulted in program expansion and innovative pilots such as the Student
to Service (S2S) Loan Repayment Program that incentivizes fourth-year
medical students to practice primary care in underserved areas after
residency training.
Once again, the AAMC appreciates the opportunity to submit this
statement for the record and looks forward to working with the
Subcommittee as it prepares its fiscal year 2015 spending bill.
______
Prepared Statement of the Association of Independent Research
Institutes
The Association of Independent Research Institutes (AIRI) thanks
the Subcommittee for its long-standing and bipartisan leadership in
support of the National Institutes of Health (NIH). We continue to
believe that science and innovation are essential if we are to continue
to improve our Nation's health, sustain our leadership in medical
research, and remain competitive in today's global information and
innovation-based economy. The Consolidated Appropriations Act of 2014
included a welcome and much needed increase for NIH. However, this
increase did not give back all of the funds cut by sequestration in
fiscal year 2013 nor did it restore the purchasing power NIH has lost
over the past decade. We hope fiscal year 2014 represents a first step
toward restoring our Nation's preeminence in medical research. AIRI
recommends that NIH receive at least $32 billion in fiscal year 2015 as
the next step toward a multi-year increase in our Nation's investment
in medical research.
AIRI is a national organization of more than 80 independent, non-
profit research institutes that perform basic and clinical research in
the biological and behavioral sciences. AIRI institutes vary in size,
with budgets ranging from a few million to hundreds of millions of
dollars. In addition, each AIRI member institution is governed by its
own independent Board of Directors, which allows our members to focus
on discovery-based research while remaining structurally nimble and
capable of adjusting their research programs to emerging areas of
inquiry. Researchers at independent research institutes consistently
exceed the success rates of the overall NIH grantee pool, and they
receive about 10 percent of NIH's peer-reviewed, competitively-awarded
extramural grants.
The partnership between NIH and America's scientists, research
institutions, universities, and medical schools is a unique and highly-
productive relationship, leveraging the full strength of our Nation's
research enterprise to foster discovery, improve our understanding of
the underlying cause of disease, and develop the next generation of
medical advancements that deliver more treatments and cures to
patients. Not only is NIH research essential to advancing health, it
also plays a key economic role in communities nationwide. Approximately
84 percent of the NIH's budget goes to more than 300,000 research
positions at over 2,500 universities and research institutions located
in every State.
The Federal Government has an irreplaceable role in supporting
medical research. No other public, corporate or charitable entity is
willing or able to provide the broad and sustained funding for the
cutting edge research necessary to yield new innovations and
technologies of the future. NIH supports long-term competitiveness for
American workers, forming one of the key foundations for U.S.
industries like biotechnology, medical device and pharmaceutical
development, and more. Unfortunately, continued erosion of the national
commitment to medical research threatens our ability to support a
medical research enterprise that is capable of taking full advantage of
existing and emerging scientific opportunities.
The NIH model for conducting biomedical research, which involves
supporting scientists at universities, medical centers, and independent
research institutes, provides an effective approach to making
fundamental discoveries in the laboratory that can be translated into
medical advances that save lives. AIRI member institutions are private,
stand-alone research centers that set their sights on the vast
frontiers of medical science. AIRI institutes are specifically focused
on pursuing knowledge around the biology and behavior of living systems
and applying that knowledge to improve human health and reduce the
burdens of illness and disability. Additionally, AIRI member institutes
have championed (and very frequently are called upon to lead)
technologies and research centers to collaborate on biological research
for all diseases. Using shared resources--specifically, advanced
technology platforms or ``cores,''--as well as genomics, next-
generation sequencing, electron and light microscopy, high-throughput
compound screening, bioinformatics, imaging, and other technologies,
AIRI researchers advance therapeutics development and drug discovery.
AIRI member institutes are especially vulnerable to reductions in
the NIH budget, as they do not have other reliable sources of revenue
to make up the shortfall. In addition to concerns over funding, AIRI
member institutes oppose legislative provisions--such as directives to
reduce the salary limit for extramural researchers--which would harm
the integrity of the research enterprise and disproportionately affect
independent research institutes. Such prescriptive policies hinder AIRI
members' research missions and their ability to recruit and retain
talented researchers. AIRI also does not support legislative language
limiting the flexibility of NIH to determine how to most effectively
manage its resources while funding the best scientific ideas.
AIRI member institutes' flexibility and research-only missions
provide an environment particularly conducive to creativity and
innovation. Independent research institutes possess a unique
versatility and culture that encourages them to share expertise,
information, and equipment across research institutions, as well as
neighboring universities. These collaborative activities help minimize
bureaucracy and increase efficiency, allowing for fruitful partnerships
in a variety of disciplines and industries. Also, unlike institutes of
higher education, AIRI member institutes focus primarily on scientific
inquiry and discovery, allowing them to respond quickly to the research
needs of the country.
AIRI members are located in 25 States, including many smaller or
less-populated States that do not have major academic research
institutions. In many of these regions, independent research institutes
are major employers and local economic engines, and they exemplify the
positive impact of investing in research and science.
The biomedical research community depends upon a knowledgeable,
skilled, and diverse workforce to address current and future critical
health research questions. While the primary function of AIRI member
institutions is research, most are highly involved in training the next
generation of biomedical researchers, ensuring that a pipeline of
promising scientists is prepared to make significant and potentially
transformative discoveries in a variety of areas. AIRI supports
policies that promote the ability of the United States to maintain a
competitive edge in biomedical science. The NIH initiatives focusing on
career development and recruitment of a diverse scientific workforce
are important to innovation in biomedical research and public health.
AIRI thanks the Subcommittee for its important work dedicated to
ensuring the health of the Nation, and we appreciate this opportunity
to urge the Subcommittee to provide $32 billion for NIH in the fiscal
year 2015 appropriations bill. AIRI also urges Congress and the
Administration to work in a bipartisan manner to end sequestration and
the continued cuts to medical research that squander valuable
scientific opportunities, discourage young scientists, threaten medical
progress and continued improvements in our Nation's health, and
jeopardize our economic future.
______
Prepared Statement of the Association of University Programs in
Occupational Health and Safety
On behalf of the Association of University Programs in Occupational
Health and Safety (AUPOHS), an organization representing the 18
multidisciplinary, university-based Education and Research Centers
(ERCs) and the ten Agricultural Centers for Disease and Injury
Research, Education, and Prevention funded by the National Institute
for Occupational Safety and Health (NIOSH), we respectfully request
that the fiscal year 2015 Labor, Health and Human Services
Appropriations bill include level funding of $27 million for the
Education and Research Centers and $24 million for the Agriculture,
Forestry and Fishing (AFF) Program within the NIOSH budget.
NIOSH is the Federal agency responsible for supporting education,
training, and research for the prevention of work-related injuries and
illnesses in the United States. The ERCs are regional resources for
parties involved with occupational health and safety--industry, labor,
government, academia, and the public. Collectively, the ERCs provide
training and research resources to every Public Health Region in the
United States. ERCs contribute to national efforts to reduce losses
associated with work-related illnesses and injuries by offering:
--Prevention Research: Developing the basic knowledge and associated
technologies to prevent work-related illnesses and injuries.
--Professional Training: ERCs support 86 graduate degree programs in
Occupational Medicine, Occupational Health Nursing, Safety
Engineering, Industrial Hygiene, and other related fields to
provide qualified professionals in essential disciplines.
--Research Training: Preparing doctoral-trained scientists who will
respond to future research challenges and who will prepare the
next generation of occupational health and safety
professionals.
--Continuing Education: Short courses designed to enhance
professional skills and maintain professional certification for
those who are currently practicing in occupational health and
safety disciplines. These courses are delivered throughout the
regions of the 18 ERCs, as well as through distance learning
technologies.
--Regional Outreach: Responding to specific requests from local
employers and workers on issues related to occupational health
and safety.
Occupational injury and illness represent a striking burden on
America's health and well-being. Despite significant improvements in
workplace safety and health over the last several decades, each year
nearly 1.2 million workers are injured seriously enough to require time
off work and, daily, an average of 11,000 U.S. workers sustain
disabling injuries on the job, 13 workers die from an injury suffered
at work, and 146 workers die from work-related diseases. This burden
costs industry and citizens an estimated $4 billion per week--$250
billion dollars per year. This is an especially tragic situation
because work-related fatalities, injuries and illnesses are preventable
with effective, professionally directed, health and safety programs.
The rapidly changing workplace continues to present new health
risks to American workers that need to be addressed through
occupational safety and health research. For example, between 2000 and
2015, the number of workers 55 years and older will increase 72 percent
to over 31 million. Work related injury and fatality rates increase at
age 45, with rates for workers 65 years and older nearly three times
greater than younger workers. In addition to changing demographics, the
rapid development of new technologies (e.g., nanotechnology) poses many
unanswered questions with regard to workplace health and safety that
require urgent attention.
The heightened awareness of terrorist threats, and the increased
responsibilities of first responders and other homeland security
professionals, illustrates the need for strengthened workplace health
and safety in the ongoing war on terror. The NIOSH ERCs play a crucial
role in preparing occupational safety and health professionals to
identify and mitigate vulnerabilities to terrorist attacks and to
increase readiness to respond to biological, chemical, or radiological
attacks. In addition, occupational health and safety professionals have
worked for several years with emergency response teams to minimize
disaster losses. For example, NIOSH took a lead role in protecting the
safety of 9/11 emergency responders in New York City and Virginia, with
ERC-trained professionals applying their technical expertise to meet
immediate protective needs and to implement evidence-based programs to
safeguard the health of clean-up workers.
Additionally, NIOSH is now administering grants to provide health
screening of World Trade Center responders. We need manpower to address
these challenges and it is the NIOSH ERCs that train the professionals
who fill key positions in health and safety programs, regionally and
around the Nation. And because ERCs provide multi-disciplinary
training, ERC graduates protect workers in virtually every walk of
life. Despite the success of the ERCs in training such qualified
professionals, the country continues to have ongoing manpower
shortages.
The Agricultural Safety and Health Centers program was established
by Congress in 1990 (Public Law 101-517) in response to evidence that
agricultural workers were suffering substantially higher rates of
occupational injury and illness than other U.S. workers.
Today the NIOSH Agriculture, Forestry, and Fishing (AFF) Initiative
includes nine regional Centers for Agricultural Disease and Injury
Research, Education, and Prevention and one national center to address
children's farm safety and health. The AFF program is the only
substantive Federal effort to meet the obligation to ensure safe
working conditions for workers in this most vital production sector.
While agriculture, forestry, and fishing constitute one of the largest
industry sectors in the U.S. (DOL 2011), most AFF operations are
themselves small: nearly 78 percent employ fewer than 10 workers, and
most rely on family members and/or immigrants, part-time, contract and
seasonal labor. Thus, many AFF workers are excluded from labor
protections, including many of those enforced by OSHA.
In 2012 the AFF sector had a work-related fatality rate of 22 per
100,000 workers, the highest of any sector in the Nation. More than 1
in 100 AFF workers incur nonfatal injuries resulting in lost work days
each year. These reported figures do not even include men, women, and
youths on farms with fewer than 11 full-time employees. In addition to
the harm to individual men, women, and families, these deaths and
injuries inflict serious economic losses including medical costs and
lost capital, productivity, and earnings. The life-saving, cost-
effective work of the NIOSH AFF program is not replicated by any other
agency:
--State and Federal OSHA personnel rely on NIOSH research in the
development of evidence-based standards for protecting
agricultural workers and would not be able to fulfill their
mission without the NIOSH AFF program.
--While committed to the well-being of farmers, the USDA has little
expertise in the medical or public health sciences. USDA no
longer funds, as it did historically, land grant university-
based farm safety specialists.
--Staff members of USDA's National Institute of Food and Agriculture
interact with NIOSH occupational safety and health research
experts to keep abreast of cutting-edge research and new
directions in this area.
NIOSH Agricultural Center activities include:
--AFF research has shown that the use of rollover protective
structures (ROPS or rollbars) and seatbelts on tractors can
prevent 99 percent of overturn-related deaths. A New York
program has increased the installation of ROPS by 10-fold and
recorded over 140 close calls with no injuries among farmers
who had installed ROPS. 99 percent of program participants said
they would recommend the program to other farmers.
--Working in partnership with producers and farm owners, the NIOSH
AFF Centers have developed evidence-based solutions for
reducing exposure to pesticides and other farm chemicals among
farmers, farm workers and their children.
--Commercial Fishing had a reported annual fatality rate 58 times
higher than the rate for all U.S. workers in 2009. Research has
shown that knowledge of maritime navigation rules and emergency
preparedness means survival. A NIOSH AFF-funded team produced
an interactive navigation training CD in three languages,
demonstrated the effectiveness of refresher survival drill
instruction, and assisted the US Coast Guard's revision of
regulations requiring commercial fishing vessel captains
complete navigation training.
--The Centers have partnered with producers, employers, the Federal
migrant health program, physicians, nurses, and Internet
Technology specialists to educate farmers, employers, and
healthcare providers about the best way to treat and prevent
agricultural injury and illness.
--In 2010, the logging industry had a reported fatality rate of 91.9
deaths per 100,000 workers (preliminary data), a rate more than
25 times higher than that of all US workers. NIOSH AFF Centers,
including the Southeast and the Northwest, are uniquely
positioned to ensure the safety of our Nation's 86,000 workers
in forestry & logging.
Thank you for the opportunity to present testimony on behalf of the
many individuals committed to working to improve the safety and well
being of others in our communities.
______
Prepared Statement of the Association of Zoos and Aquariums
Thank you Chairman Harkin and Ranking Member Moran for allowing me
to submit testimony on behalf of the Nation's 213 U.S. accredited zoos
and aquariums. Specifically, I want to express my support for the
inclusion of $38.6 million for the Institute of Museum and Library
Services' (IMLS) Office of Museum Services in the fiscal year 2015
Labor, Health and Human Services, Education, and Related Agencies
appropriations bill.
Founded in 1924, the Association of Zoos and Aquariums (AZA) is a
nonprofit 501c(3) organization dedicated to the advancement of zoos and
aquariums in the areas of conservation, education, science, and
recreation. Accredited zoos and aquariums annually see more than 182
million visitors, collectively generate more than $21 billion in annual
economic activity, and support more than 204,000 jobs across the
country. Over the last 5 years, AZA-accredited institutions supported
more than 4,000 field conservation and research projects with
$160,000,000 annually in more than 100 countries. In the last 10 years,
accredited zoos and aquariums formally trained more than 400,000
teachers, supporting science curricula with effective teaching
materials and hands-on opportunities. School field trips annually
connect more than 12,000,000 students with the natural world.
Aquariums and zoological parks are defined by the ``Museum and
Library Services Act of 2003'' (Public Law 108-81) as museums. The
Office of Museum Services awards grants to museums to support them as
institutions of learning and exploration, and keepers of cultural,
historical, and scientific heritages. Grants are awarded in several
areas including educational programming, professional development, and
collections management, among others.
The Nation's accredited zoos and aquariums, even while facing
budget limitations, are thriving during these uncertain economic times.
As valued members of local communities, zoos and aquariums offer a
variety of programs ranging from unique educational opportunities for
schoolchildren to conservation initiatives that benefit both local and
global species. The competitive grants offered by the IMLS Office of
Museum Services ensure that many of these programs, which otherwise may
not exist because of insufficient funds, positively impact local
communities and many varieties of species.
For example, with a 2013 Museums for America--Collections
Stewardship grant the Toledo Zoo will obtain new life support systems
for an interactive visitor touch tank containing invertebrates and
another holding sharks and stingrays. The exhibits provide multi-
sensory experiences that connect people with animals, while the systems
ensure the animals are properly cared for. Through its 2012 Museums for
American grant, the Birmingham Zoo supported its Africa Zoo School
program, which is serving 1,200 students over 2 years. Partnering with
Birmingham City School, seventh-grade students from low-performing
schools attend a week-long ``Zoo School'' session, where they learn
about the crisis of the elephant species' survival in Africa, the
cultures of people in Africa, and the scientific and engineering
research involved in sustaining these populations. Finally, a 2011
Museums for America grant enabled The National Aquarium in Baltimore to
create a more robust volunteer program by developing and testing new
techniques to attract, train, engage, and retain a new generation of
more diverse volunteers.
Unfortunately, current funding has allowed IMLS to fund only a
small fraction of all highly-rated grant applications. Despite this
funding shortfall, zoo and aquarium attendance has increased and the
educational services zoos and aquariums provide to schools and
communities are in greater demand than ever. Zoos and aquariums are
essential partners at the Federal, State, and local levels in providing
education and cultural opportunities that adults and children may
otherwise never enjoy.
As museums, zoos and aquariums share the same mission of preserving
the world's great treasures, educating the public about them, and
contributing to the Nation's economic and cultural vitality. Therefore,
I strongly encourage you to include $38.6 million for the Institute of
Museum and Library Services' Office of Museum Services in the fiscal
year 2015 Labor, Health and Human Services, Education, and Related
Agencies appropriations bill.
Thank you.
[This statement was submitted by Jim Maddy, President and CEO,
Association of Zoos and Aquariums.]
______
Prepared Statement of the Brain Injury Association of America
Chairman Harkin and Ranking Member Moran, thank you for the
opportunity to submit this written testimony with regard to the fiscal
year 2015 Labor-HHS-Education appropriations bill. This testimony is on
behalf of the Brain Injury Association of America (BIAA), our network
of State affiliates, and hundreds of local chapters and support groups
from across the country.
In the civilian population alone every year, more than 2.5 million
people sustain brain injuries from falls, car crashes, assaults and
contact sports. Males are more likely than females to sustain brain
injuries. Children, teens and seniors are at greatest risk.
Increasing numbers of service members returning from the conflicts
in Iraq and Afghanistan with TBI and their families are seeking
resources for information to better understand TBI and to obtain vital
support services to facilitate successful reintegration into their
communities.
Since 1997, Congress has provided minimal funding through the
Health Resources and Services Administration (HRSA) Federal TBI Program
to assist States in developing services and systems to help individuals
with brain injuries and their families who have a broad range of
service and support needs. . Similarly, Congress has appropriated funds
to HRSA for grants to State Protection and Advocacy Systems to assist
individuals with TBI in accessing services through education, legal and
advocacy remedies, but the program is woefully underfunded.
Rehabilitation, community support and long-term care systems are still
developing in many States, while stretched to capacity in others.
Additional numbers of individuals with TBI as the result of war-related
injuries only adds more stress to these inadequately funded systems.
BIAA respectfully urges you to provide States with the resources
they need to address both the civilian and military populations that
look to them for much needed support in order to live and work in their
communities.
With broader regard to all of the programs authorized through the
TBI Act, BIAA specifically requests:
--$10 million (+ $4 million) for the Centers for Disease Control and
Prevention TBI Registries and Surveillance, Brain Injury Acute
Care Guidelines, Prevention and National Public Education/
Awareness
--$12 million (+ $1 million) for the Health Resources and Services
Administration (HRSA) Federal TBI State Grant Program
--$4 million (+ $1 million) for the HRSA Federal TBI Protection &
Advocacy (P&A) Systems Grant Program
CDC--National Injury Center--The Centers for Disease Control and
Prevention's National Injury Center is responsible for assessing the
incidence and prevalence of TBI in the United States. The CDC estimates
that 2.5 million TBIs occur each year and 5.3 million Americans live
with a life-long disability as a result of TBI. The TBI Act as amended
in 2008 requires the CDC to coordinate with the Departments of Defense
and Veterans Affairs to include the number of TBIs occurring in the
military. This coordination will likely increase CDC's estimate of the
number of Americans sustaining TBI and living with the consequences.
CDC also funds States for TBI registries, creates and disseminates
public and professional educational materials, for families, caregivers
and medical personnel, and has recently collaborated with the National
Football League and National Hockey League to improve awareness of the
incidence of concussion in sports. CDC plays a leading role in helping
standardize evidence based guidelines for the management of TBI and $1
million of this request would go to fund CDC's work in this area.
HRSA TBI State Grant Program--The TBI Act authorizes HRSA to award
grants to (1) States, American Indian Consortia and territories to
improve access to service delivery and to (2) State Protection and
Advocacy (P&A) Systems to expand advocacy services to include
individuals with traumatic brain injury. Since 1997, the HRSA Federal
TBI State Grant Program has supported State efforts to address the
needs of persons with brain injury and their families and to expand and
improve services to underserved and unserved populations including
children and youth; veterans and returning troops; and individuals with
co-occurring conditions
In fiscal year 2009, HRSA reduced the number of State grant awards
to 21, in order to increase each monetary award from $118,000 to
$250,000. This means that many States that had participated in the
program in prior years have now been forced to close down their
operations, leaving many individuals with brain injury and their
families unable to access needed care and supports.
Increasing the program to $8 million will provide funding necessary
to sustain the grants for the 21 States currently receiving funding
along with the three additional States added this year and to ensure
funding for four additional States. Steady increases over 5 years for
this program will provide for each State including the District of
Columbia and the American Indian Consortium and territories to sustain
and expand State service delivery; and to expand the use of the grant
funds to pay for such services as Information & Referral (I&R), systems
coordination and other necessary services and supports identified by
the State.
HRSA TBI P&A Program--Similarly, the HRSA TBI P&A Program currently
provides funding to all State P&A systems for purposes of protecting
the legal and human rights of individuals with TBI. State P&As provide
a wide range of activities including training in self-advocacy,
outreach, information & referral and legal assistance to people
residing in nursing homes, to returning military seeking veterans
benefits, and students who need educational services.
Effective Protection and Advocacy services for people with
traumatic brain injury is needed to help reduce government expenditures
and increase productivity, independence and community integration.
However, advocates must possess specialized skills, and their work is
often time-intensive. A $4 million appropriation would ensure that each
P&A can move towards providing a significant PATBI program with
appropriate staff time and expertise.
NIDRR TBI Model Systems of Care--Funding for the TBI Model Systems
in the Department of Education is urgently needed to ensure that the
Nation's valuable TBI research capacity is not diminished, and to
maintain and build upon the 16 TBI Model Systems research centers
around the country.
The TBI Model Systems of Care program represents an already
existing vital national network of expertise and research in the field
of TBI, and weakening this program would have resounding effects on
both military and civilian populations. The TBI Model Systems are the
only source of non-proprietary longitudinal data on what happens to
people with brain injury. They are a key source of evidence-based
medicine, and serve as a ``proving ground'' for future researchers.
In order to make this program more comprehensive, Congress should
provide $13 million (+ $1.5 million) in fiscal year 2015 for NIDRR's
TBI Model Systems of Care program, in order to add two new
Collaborative Research Projects. In addition, given the national
importance of this research program, the TBI Model Systems of Care
should receive ``line-item'' status within the broader NIDRR budget.
We ask that you consider favorably these requests for the CDC, the
HRSA Federal TBI Program, and the NIDRR TBI Model Systems Program to
further data collection, increase public awareness, improve medical
care, assist States in coordinating services, protect the rights of
persons with TBI, and bolster vital research.
______
Prepared Statement of the California Association of Psychiatric
Technicians
introduction
On behalf of approximately 14,000 California Licensed Psychiatric
Technicians representing the Nation's ``gold standard'' in direct-care
nursing services for people with developmental disabilities and mental
illnesses, I am writing to respectfully request that the Subcommittee,
Committee and Congress as a whole end the practice of using Federal
funds to downsize and close federally regulated and accredited homes
for Americans with developmental disabilities.
individuals and families caught in a federal web of ironies
In recent years, the national demand for developmental centers'
closure has come perhaps most strongly--and, perhaps, most
surprisingly--from the Federal Government: the very Federal Government
which requires developmental centers to meet its own regulatory
standards.
To be federally certified through the U.S. Centers for Medicare and
Medicaid Services, State developmental centers must meet eight major
criteria on management, client protections, facility staffing, active
treatment, client behavior and facility practices, healthcare services,
physical environment and dietetic services. To meet all of these major
criteria, developmental centers must comply with 378 specific Federal
standards and elements. Failure to comply with any one of these
hundreds of requirements or to swiftly correct any deficiencies means
the loss of Federal certification as well as Federal Medicaid funding.
But in an interesting twist, other Federal funds go to support the
efforts of the Protection and Advocacy system. Created by Congress,
this federally mandated system acts as a legally based advocacy
provider for people with developmental disabilities and other mental
and physical disabilities throughout the Nation. Each State has a P&A
branch to investigate allegations of discrimination, abuse or other
concerns affecting Americans with disabilities, wherever they reside.
The P&A system and other Federal laws arose as responses to
widespread concerns of neglect and abuse at an unlicensed New York
developmental center called Willowbrook State School more than 40 years
ago. The system and laws are the bases for the regulations that today's
developmental centers must follow to achieve and continue Federal
accreditation. However, nothing in this system or laws require the
closure of developmental centers. In the case of the Federal law which
creates P&As--the Developmental Disabilities Assistance and Bill of
Rights Act (often called the ``DD Act'')--P&As' board charge is to
``protect and advocate'' for people with disabilities regardless of
where they reside. In the DD Act's legislative history, Congress
expressly cautioned against interpreting the act as mandating closures:
``The goals expressed in this act to promote the greatest possible
integration and independence for some individuals with developmental
disabilities may not be read as a Federal policy supporting the closure
of residential institutions... .'' This Congressional intent is
reinforced in the act itself, where individuals and their families, and
no one else, are named as the ``primary decisionmakers'' regarding
services (including residential supports) and policies.
u.s. supreme court supports residential choice
To add to the paradox, another Federal group--none other than the
U.S. Supreme Court--made key points in its touchstone 1999 Olmstead
ruling:
``We emphasize that nothing in the [Americans with Disabilities
Act] or its implementing regulations condone termination of
institutional settings for persons unable to handle or benefit from
community settings...Nor is there any Federal requirement that
community-based treatment be imposed on patients who do not desire
it.''
The overall tragic irony of this Kafkaesque situation is not lost
on those advocating for loved ones to have the choice of living in
federally regulated and certified facilities. Adding to the personal
and emotional toll of advocating to keep their loved ones'
developmental-center homes open, family members must use their own
personal funds to fight the deep pockets of federally funded P&A and
DOJ attorneys seeking center closures that families and residents often
do not wish. Federal funds are being used by one Federal agency to sue
another Federal agency for the purpose of evicting our Nation's most
vulnerable people from their homes. In addition to wasting taxpayer
dollars, it defies common sense and human decency.
what does `most integrated' mean?
Those taking aim at developmental centers, in the Federal
Government or elsewhere, feel that the centers are not the most
integrated settings possible for those with developmental disabilities.
But the ADA defines ``most integrated setting'' to be ``a setting that
enables individuals with disabilities to interact with non-disabled
persons to the fullest extent possible [emphasis added].''
Families with loved ones in developmental centers who wish to
continue their services strongly disagree with any interpretation that
their family members are, in any way, restricted. They feel that the
many on-site services offered at a developmental center provide the
most integrated environments possible, allowing their loved ones live
securely and to meet their fullest potentials.
Professional developmental-center staff also echo families'
concerns about how many group homes and placements with less safety and
oversight and fewer programs can be less ``restrictive.'' Developmental
centers are required by Federal and State regulations to have dozens
and dozens of federally regulated state-of-the-art therapeutic and
rehabilitative programs in place, right there on grounds as well as in
the broader community; but somehow a developmental center is always
painted as ``less integrated'' and ``more restrictive'' than a house on
a busy street with a postage-stamp yard, occasional visits by licensed
staff, few or no programs and infrequent and pre-announced visits by
State regulators.
California's Licensed Psychiatric Technicians are not ```anti-
``community'''--in fact, we actively advocate for group-home placements
when it is in the clients' best interests and is what they and their
families wish. However, when taken as a whole, how is having more
space, more programs both on and off the center campus, higher
regulatory standards and a whole community of professionals there to
help Americans enjoy the healthiest, happiest and most active life
possible necessarily ``more restrictive?''
end the paradox: stop funding restrictions on federal choices
On behalf of CAPT and its dedicated professional membership, I wish
to respectfully request that the Subcommittee and Congress as a whole
end the use of Federal appropriations to discourage, downsize and close
federally regulated developmental centers (``ICF/DDs and ICF/MRs'')
throughout the country. It is the legal and moral choice and right for
people with developmental disabilities and their loved ones to make
decisions on their individual residential, service and support needs,
and the choice of federally regulated developmental centers and related
congregate settings should remain an option for them. Our Federal
Government should not play a role in restricting or eliminating any
viable, recognized and desired option for Americans with developmental
disabilities.
[This statement was submitted by Juan Nolasco, PT, State President,
California Association of Psychiatric Technicians.]
______
Prepared Statement of the California Association of State Hospital
Parent Councils for the Retarded
Dear Chairman Harkin and Members of the Subcommittee: The
California Association of State Hospital Parent Councils for the
Retarded (CASHPCR) represents the families, friends, and advocates of
loved ones living at Porterville Developmental Center and Fairview
Developmental Center.
As President of CASHPCR, a healthcare professional, and the sister
of someone with a developmental disability, I am writing to urge the
Senate Appropriations Labor, Health and Human Services (HHS), Education
and Related Agencies to prohibit the use of Federal HHS appropriations
in support of deinstitutionalization activities which evict, without
regard to individual choice, eligible individuals with intellectual and
developmental disabilities (I/DD) from their HHS-licensed and funded
homes.
The ability of our family members and others with developmental
disabilities to achieve their full potential is greatly dependent upon
the services and supports that they receive, including housing, medical
care, and developmental programs. The homes licensed and funded by HHS
are an important option for many individuals--in some cases, the only
option.
VOR, a national nonprofit organization advocating for high quality
care and human rights for all people with I/DD, has submitted written
testimony for the record with this same request.
I support VOR's testimony and request.
[This statement was submitted by Theresa DeBell, R.N., California
Association of State Hospital Parent Councils for the Retarded.]
______
Prepared Statement of the Centers for Disease Control and Prevention
Coalition
The Centers for Disease Control and Prevention (CDC) Coalition is a
nonpartisan coalition of more than 140 organizations committed to
strengthening our Nation's prevention programs. We represent millions
of public health workers, clinicians, researchers, educators and
citizens served by CDC programs.
We believe Congress should support CDC as an agency, not just the
individual programs that it funds. Given the challenges and burdens of
chronic disease and disability, public health emergencies, new and
reemerging infectious diseases and other unmet public health needs, we
urge a funding level of $7.8 billion for CDC's programs in fiscal year
2015. We appreciate some of the important new investments in President
Obama's fiscal year 2015 budget proposal including those for
prescription drug overdose prevention, antimicrobial resistance and
global health security; however, under the president's proposal, CDC's
budget would be cut by nearly $243 million compared to fiscal year
2014. CDC's budget authority under the president's budget is lower than
fiscal year 2003 levels. State and local health departments continue to
operate on tight budgets and with a smaller workforce, losing more than
50,000 public health jobs since 2008. These cuts will reduce the
ability of CDC and its State and local grantees to investigate and
respond to public health emergencies, ensure adequate immunization
rates and track environmental hazards.
CDC is a key source of funding and technical assistance for State
and local programs that aim to improve the health of communities. CDC
funding provides the foundation for State and local public health
departments, supporting a trained workforce, laboratory capacity and
public health education communications systems. CDC serves as the
command center for our Nation's public health defense system,
conducting surveillance and detection of emerging and reemerging
infectious diseases. With the potential onset of a worldwide influenza
pandemic, in addition to the many other natural and man-made threats
that exist in the modern world, CDC is the Nation's expert resource and
response center, coordinating communications and action and serving as
the laboratory reference center for identifying, testing and
characterizing potential agents of biological, chemical and
radiological terrorism, emerging infectious diseases and other public
health emergencies. CDC serves as the lead agency for bioterrorism and
public health emergency preparedness and must receive sustained support
for its preparedness programs to meet future challenges. We urge you to
provide adequate funding for CDC's emergency preparedness and response
activities.
Heart disease is the Nation's No. 1 killer. In 2010, over 597,000
people in the U.S. died from heart disease, accounting for nearly 25
percent of all U.S. deaths. More males than females died of heart
disease in 2010, while more females than males died of stroke that
year. Stroke is the fourth leading cause of death and is a leading
cause of disability. In 2010, more than 129,000 people died of stroke,
accounting for about one of every 19 deaths. CDC's Heart Disease and
Stroke Prevention Program, WISEWOMAN, and the Million Hearts program
work to improve cardiovascular health.
Cancer is the second most common cause of death in the U.S. More
than1.6 million new cancer cases and 585,720 deaths from cancer are
expected in 2014. In 2009 the overall cost for cancer in the U.S. was
more than $216.6 billion: $86.6 billion for direct medical costs, $130
billion for indirect mortality costs. CDC's National Breast and
Cervical Cancer Early Detection Program helps millions of low-income,
uninsured and medically underserved women gain access to lifesaving
breast and cervical cancer screenings and provides a gateway to
treatment upon diagnosis. CDC also funds grants to all 50 States to
develop comprehensive cancer control plans, bringing together a broad
partnership of public and private stakeholders to set joint priorities
and implement specific cancer prevention and control activities
customized to address each State's particular needs.
An estimated 443,000 people die prematurely every year due to
tobacco use. CDC's Office of Smoking and Health funds important
programs and campaigns to prevent tobacco addiction and to help those
who want to quit. We must continue to support these vital programs to
reduce the enormous health and economic costs of tobacco use in the
U.S.
Of the 25.8 million Americans who have diabetes, nearly 7 million
cases are undiagnosed. In 2010, about 1.9 million people aged 20 years
or older were newly diagnosed with diabetes. Diabetes is the leading
cause of kidney failure, nontraumatic lower-limb amputations, and new
cases of blindness among adults in the U.S. The total direct and
indirect costs associated with diabetes were $245 billion in 2012. The
Division of Diabetes Translation funds critical diabetes prevention,
surveillance and control programs.
Obesity prevalence in the U.S. remains high. While the obesity
rates among children between the ages of 2-5 have significantly
decreased over the past decade, more than one-third of adults are obese
and 17 percent of children are obese. Obesity, diet and inactivity are
cross-cutting risk factors that contribute significantly to heart
disease, cancer, stroke and diabetes. CDC funds programs to encourage
the consumption of fruits and vegetables, encourage sufficient exercise
and develop other habits of healthy nutrition and physical activity.
Arthritis is the most common cause of disability in the U.S.,
striking more than 52 million Americans of all ages, races and
ethnicities. CDC's Arthritis Program plays a critical role in
addressing this growing public health crisis and working to improve the
quality of life for individuals affected by arthritis.
CDC provides national leadership in helping control the HIV
epidemic by working with community, State, national, and international
partners in surveillance, research, prevention and evaluation
activities. CDC estimates that about 1.1 million Americans are living
with HIV, 16 percent of who are undiagnosed. The number of people
living with HIV is increasing as new drug therapies are keeping HIV-
infected persons healthy longer and dramatically reducing the death
rate. Prevention of HIV transmission is the best defense against the
AIDS epidemic that has already killed more than 636,000 in the U.S. and
is devastating populations around the globe.
The U.S. has the highest rates of sexually transmitted diseases in
the industrialized world. Nearly 20 million new infections occur each
year. CDC estimates that STDs, including HIV, cost the U.S. healthcare
system almost $16 billion annually. An adequate investment in CDC's STD
prevention programs could save millions in annual healthcare costs in
the future.
The National Center for Health Statistics collects data on chronic
disease prevalence, health disparities, emergency room use, teen
pregnancy, infant mortality and causes of death. The health data
collected through the Behavioral Risk Factor Surveillance System, Youth
Risk Behavior Survey, Youth Tobacco Survey, National Vital Statistics
System, and National Health and Nutrition Examination Survey are an
essential part of the Nation's statistical and public health
infrastructure and must be adequately funded.
CDC oversees immunization programs for children, adolescents and
adults, and is a global partner in the ongoing effort to eradicate
polio worldwide. Influenza vaccination levels remain low for adults.
Levels are substantially lower for pneumococcal vaccination among
adults as well, with significant racial and ethnic disparities in
vaccination levels persisting among the elderly. Childhood
immunizations provide one of the best returns on investment of any
public health program. For every dollar spent on childhood vaccines to
prevent thirteen diseases, $10.20 is saved in direct and indirect
costs. An estimated 20 million cases of disease and 42,000 deaths are
prevented each year through timely immunization.
Injuries are the leading causes of death for people ages 1-44.
Unintentional injuries and violence, such as older adult falls,
prescription drug overdose, child maltreatment and sexual violence,
account for approximately 29 percent of emergency department visits
each year. Annually, injury and violence cost the U.S. approximately
$406 billion in direct and indirect medical costs. The National Center
for Injury Prevention and Control works to prevent injuries and
minimize their consequences by researching the problem, identifying the
risk and protective factors, developing and testing interventions and
ensuring widespread adoption of proven prevention strategies.
Birth defects affect one in 33 babies and are a leading cause of
infant death in the U.S. Children with birth defects who survive often
experience lifelong physical and mental disabilities. Over 500,000
children are diagnosed with a developmental disability and more than 50
million people in the U.S. currently live with a disability. The
National Center on Birth Defects and Developmental Disabilities
conducts important programs to prevent birth defects and developmental
disabilities and promote the health of people living with disabilities
and blood disorders.
The National Center for Environmental Health works to protect
public health by helping to control asthma, protecting from threats
associated with natural disasters and climate change and reducing
exposure to lead and other environmental hazards. To ensure it can
carry out these vital programs, we ask you to support and restore
adequate funding for NCEH.
In order to meet the many ongoing public health challenges outlined
above, we urge you to support our fiscal year 2015 request of $7.8
billion for CDC's programs.
[This statement was submitted by Donald Hoppert, Director,
Government Relations, American Public Health Association.]
______
Prepared Statement of the Children's Environmental Health Network
The Children's Environmental Health Network (CEHN or the Network)
is pleased to have this opportunity to submit testimony on fiscal year
2015 appropriations for the following programs and activities that
safeguard the health and future of all of our children:
--Centers for Disease Control and Prevention ($7.8 billion),
especially the National Center for Environmental Health ($181.1
million) and its programs, including:
--Healthy Homes and Lead Poisoning Prevention Program ($29 million)
--National Asthma Control Program ($28 million)
--National Environmental Public Health Tracking Program ($40
million)
--National Institute of Environmental Health Sciences (NIEHS) ($717.7
million), especially the Children's Environmental Health
Research Centers ($33 million)
--Pediatric Environmental Health Specialty Units (PEHSUs) ($2
million)
The Children's Environmental Health Network (CEHN) was created more
than 20 years ago by concerned pediatricians and researchers with a
goal of protecting the developing child from environmental health
hazards and to promote a healthy environment.
Today's children are facing the distressing possibility that they
may be the first generation to see a shorter life expectancy than their
parents due to poor health. Key contributors to this trend are the
modern pediatric epidemics of obesity, asthma, learning disabilities,
and autism. For all of these conditions, the child's environment plays
a role in causing, contributing to or mitigating these chronic
conditions. The estimated costs of environmental disease in children
(such as lead poisoning, childhood cancer, and asthma) were $76.6
billion in 2008.\1\
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\1\ Trasande, Liu Y. ``Reducing The Staggering Costs Of
Environmental Disease In Children, Estimated At $76.6 Billion In 2008,
Health Affairs. No. (2011): doi: 10.1377/hlthaff.2010.1239.
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Investments in programs that protect and promote children's health
will be repaid by healthier children with brighter futures.
Additionally, protecting our children--those born as well as those
yet to be born--from environmental hazards is truly a national security
issue. When we protect children from harmful chemicals in their
environment, we help to assure that they will reach their full
potential. We have a responsibility to our Nation's children, and to
the Nation that they will someday lead, to provide them with a healthy
environment. American competitiveness depends on having healthy,
educated children who grow up to be healthy productive adults. Thus it
is vital that the Federal programs and activities that protect children
from environmental hazards receive adequate resources. We strongly urge
the Committee to support and expand children's environmental health
programs. Key programs in your jurisdiction deserving your support
include:
Centers for Disease Control and Prevention (CDC)
As the Nation's leader in public health promotion and disease
prevention, the CDC should receive top priority in Federal funding. CDC
continues to be faced with unprecedented challenges and
responsibilities. CEHN applauds your support for CDC in past years and
urges you to support a funding level of $7.8 billion for CDC's core
programs in fiscal year 2015.
The National Center for Environmental Health (NCEH) is particularly
important in protecting the environmental health of young children.
Current research is uncovering the extensive role that environment
plays in human health and development. As a result, NCEH partners with
public health agencies and a wide range of other organizations to bring
their expertise and support to an expanding scope of environmental-
human health challenges. NCEH's programs are key national assets. Yet
in recent years, NCEH funding has been drastically cut. We urge the
Subcommittee to at least restore NCEH to its fiscal year 2010 funding
level of $181.1 million.
We were deeply concerned with the fiscal year 2012 gutting of the
Healthy Homes and Lead Poisoning Prevention Program and we commend you
for the substantial increase the program received in fiscal year 2014.
This program helps to prevent lead poisoning and helps children who
have already been exposed to lead. Much more needs to be done just to
return it to fiscal year 2011 levels. Millions of American children
remain at risk of lead poisoning and need this program, which supports
effective local and State efforts. As evidence increasingly
demonstrates no safe level of lead exposure for children, this funding
is all the more essential. We join with the National Safe and Healthy
Housing Coalition to urge a funding level of $29 million in fiscal year
2015.
NCEH's National Asthma Control Program not only has greatly
increased data collection about this rampant epidemic but it also
encourages States to use evidence-based approaches to reduce costs and
improve outcomes for people living with asthma. Asthma is an epidemic
in the U.S., affecting 10 percent of our Nation's children. We urge the
Committee to fund this vital program at $28 million in fiscal year
2015.
Public health officials need integrated health and environmental
data so that they can protect the public's health. The CDC's National
Environmental Public Health Tracking Program helps to track
environmental hazards and the diseases they may cause and to coordinate
and integrate local, State and Federal health agencies' collection of
critical health and environmental data. Participation in the tracking
network development will decline under further cuts and erase the
progress we have made across the country to better link data with
public health action.
National Institute of Environmental Health Science (NIEHS)
NIEHS is the leading institute conducting research to understand
how the environment influences human health. Unlike other NIH
Institutes focused on one disease or one body system, NIEHS is charged
with all diseases, all human health and body systems, as they are
affected by the environment--a vital and monumental charge. NIEHS plays
a critical role in our efforts to understand how to protect children,
whether it is identifying and understanding the immediate impact of
chemical substances or understanding childhood exposures that may not
affect health until decades later. CEHN recommends that $717.7 million
be provided for NIEHS' fiscal year 2015 budget.
Children's Environmental Health Research Centers of Excellence
The Children's Environmental Health & Disease Prevention Research
Centers, jointly funded by the NIEHS and the U.S. Environmental
Protection Agency (EPA) and located at research institutions across the
Nation, play a vital role in providing the scientific basis for
protecting children from environmental hazards. With their modest
budgets, these centers are generating invaluable research. For example,
these centers conducted the recent research that found links between
prenatal exposures to either a common air pollutant or a common
pesticide to lower IQs and poorer working memory at age 7.
Several Centers have established longitudinal cohorts, which in
some cases are more than 10 years old. The ability to look for linkages
between exposures and health outcomes in infants, toddlers, and, now,
adolescents, is vital. If these cohorts are disbanded due to funding
cuts, at best it will take years and untold resources before it is
possible to replicate them. Few if any longitudinal cohort studies on
adolescents, puberty and environmental exposures exist. The Network is
concerned that inadequate funding may result in the loss of these
valuable cohorts. We urge the Subcommittee to support these centers at
$33 million in fiscal year 2015.
Pediatric Environmental Health Specialty Units
Pediatric Environmental Health Specialty Units (PEHSUs) form a
valuable resource network for parents and clinicians around the Nation.
They are funded jointly by the Agency for Toxic Substances and Disease
Registry (ATSDR) and the EPA with a very modest budget. PEHSU
professionals provide medical consultation to healthcare professionals
from individual cases of exposure to advice regarding large-scale
community issues. PEHSUs also provide information and resources to
school, child care, health and medical, and community groups and help
inform policymakers by providing data and background on local or
regional environmental health issues and implications for specific
populations or areas. We urge the Subcommittee to fully fund ATSDR's
portion of this program in fiscal year 2015.
In conclusion, our Nation's future will depend upon its future
leaders. Protecting children from harmful chemicals in their
environment will result in healthier children with brighter futures, an
outcome we can all support. Thank you for the opportunity to testify.
______
Prepared Statement of the Children's Hospital Association
The Children's Hospital Association advances child health through
innovation in the quality, cost and delivery of care. Representing more
than 220 children's hospitals, the Association is the voice of
children's hospitals nationally. As institutions dedicated to
protecting and advancing the health of America's children, we thank the
Subcommittee for its longstanding bipartisan support of the Children's
Hospital Graduate Medical Education program (CHGME).
CHGME is an essential investment in our children's healthcare--in
promoting prevention and primary care, expanding healthcare for
vulnerable and underserved children, and ensuring access to care for
all children. The Children's Hospitals Association urges the
Subcommittee to protect this important program and provide $300 million
in funding for CHGME in fiscal year 2015.
The CHGME program protects children's access to high-quality
medical care by providing independent children's hospitals with funding
to support the training of pediatric providers, much as Medicare
supports training in adult teaching hospitals. CHGME funding has had a
tremendous impact, enabling children's hospitals to increase their
overall training by more than 45 percent since the program began in
1999. In addition, the CHGME program has accounted for more than 74
percent of the growth in the number of new pediatric subspecialists
being trained nationwide.
Today, the 55 hospitals that receive CHGME, less than 1 percent of
all hospitals, train over 6,000 residents annually, and 49 percent of
all pediatric residents in the country, including 45 percent of general
pediatricians and 51 percent of pediatric specialists. CHGME benefits
all children, supporting the training of doctors who go on to care for
children living in every State--in cities, rural communities, suburbs
and everywhere in between. Furthermore, CHGME is an example of a well-
functioning public-private partnership; each of the participating
children's hospitals invests significant resources into the success of
their training programs along with the Federal dollars they receive.
Since the program's beginning, CHGME has enjoyed strong, bipartisan
support in Congress, under both Republican and Democratic leadership.
Congress created CHGME because it recognized that the absence of
dedicated GME support for independent children's teaching hospitals
created gaps in the training of pediatric providers, which potentially
threatened access to care for children. At that time, independent
children's hospitals were effectively left out of Federal GME support
provided through Medicare because children's hospitals treat children
and not the elderly, and received less than 0.5 percent of the GME
support of other teaching hospitals.
CHGME has helped close the gap, but support for training of
pediatric providers in children's hospitals still lags significantly
behind Medicare support for graduate medical education. Analysis
commissioned by the Children's Hospitals Association shows that in 2014
CHGME provides children's hospitals, on a per-resident basis, about 45
percent of the support Medicare provides to adult teaching hospitals.
Continued funding is essential to maintaining the gains that have
been achieved under CHGME and strengthening the pediatric workforce
pipeline. While much has been achieved, much remains to be done, as
serious shortages persist in many pediatric specialties. The shortages
affect children and their families' ability to receive timely,
appropriate care, including surgery. Children's hospital clinics use a
two-week benchmark when scheduling non-emergency appointments, but
certain pediatric specialties experiencing physician shortages have
wait times of 14.5 weeks or more, far exceeding the two-week standard.
Unfortunately, funding for the CHGME program has been significantly
reduced in recent years, from $317.5 million in fiscal year 2010 to
$265 million in 2014, a 17 percent reduction. These cuts hurt the
ability of children's hospitals to train enough pediatricians and
pediatric specialists to keep up with growing demand at local, State
and national levels.
Furthermore, there are no adequate substitutes for CHGME. Other
potential sources of support, such as Medicaid GME or competitive
grants, are not available to many children's hospitals and cannot come
close to supporting training on the scale necessary to meet workforce
needs. Failing to adequately support CHGME would take us back to the
same flawed system that was not meeting the needs of America's
children.
The White House's fiscal year 2015 budget proposes eliminating
funding for CHGME and incorporating support for training at children's
hospitals into a new competitive grant program under the Health
Resources and Services Administration (the program would have to be
created by Congress), funded from Medicare trust fund dollars, with
$100 million set aside specifically for children's hospitals in fiscal
year 2015 and fiscal year 2016. While we recognize that the White House
includes funding for training in children's hospitals in the budget,
the administration's proposal continues to underfund pediatric
training. Furthermore, children's hospitals have strong concerns that
replacing the current system with competitive grants that are limited
in duration puts at risk the gains that have been made for children's
health under CHGME. Children's hospitals welcome the idea of engaging
with the administration and Congress on ways to strengthen the
pediatric workforce for the future. In the present, however, financial
support for GME in children's hospitals needs to be uninterrupted and
undiminished.
We recognize that the current budget climate is extraordinarily
challenging and that Congress has a responsibility to carefully
consider the Nation's spending priorities. However, now is not the time
to take a step backwards in pediatric medicine. The CHGME program is
critical to protecting gains in pediatric health and ensuring access to
care for children nationwide.
We respectfully request that the Subcommittee continue its history
of bipartisan support for the CHGME program and include $300 million in
funding in the fiscal year 2015 Labor-HHS appropriations bill for this
vital program.
The Children's Hospital Association, and the children and families
we serve, thank you for your past support for this critical program and
your leadership in protecting children's health.
The Children's Hospital Association advances child health through
innovation in the quality, cost and delivery of care. Representing more
than 220 children's hospitals, the Association is the voice of
children's hospitals nationally. The Association champions public
policies that enable hospitals to better serve children and is the
premier resource for pediatric data and analytics, driving improved
clinical and operational performance of member hospitals. Formed in
2011, Children's Hospital Association brings together the strengths and
talents of three organizations: Child Health Corporation of America
(CHCA), National Association of Children's Hospitals and Related
Institutions (NACHRI) and National Association of Children's Hospitals
(N.A.C.H.). The Children's Hospital Association has offices in
Washington, DC, and Overland Park, KS.
______
Prepared Statement of the Coalition for Clinical and Translational
Science
Chairman Harkin and distinguished members of the Subcommittee,
thank you for your time and your consideration of the priorities of the
clinical and translational research community as you work to craft the
fiscal year 2015 Labor, Health and Human Services Appropriations Bill.
The community would like to thank you for your past support of the full
spectrum of medical research.
about the coalition for clinical and translational science
Coalition for Clinical and Translational Science (CCTS) is the
unified voice of the clinical and translational science research
community. CCTS is a nationwide, grassroots network of dedicated
individuals who work together to educate Congress and the
Administration about the value and importance of Federal clinical and
translational research and research training and career development
activities. CCTS's goals are to ensure that the full spectrum of
medical research is adequately funded, the next generation of
researchers is well-prepared, and the regulatory and public policy
environment facilitates ongoing expansion and advancement of the field
of clinical and translational science.
Association for Clinical and Translational Science (ACTS)
ACTS supports investigations that continually improve team science,
integrating multiple disciplines across the full translational science
spectrum: from population based and policy research, through patient
oriented and human subject clinical research, to basic discovery. Our
goal is to improve the efficiency with which health needs inform
research and new therapies reach the public.
ACTS is the academic home for the disciplines of research
education, training, and career development for the full spectrum of
translational scientists. Through meetings, publications, and
collaborative efforts, ACTS will provide a forum for members to
develop, implement, and evaluate the impact of research education
programs.
ACTS provides a strong voice to advocate for translational science,
clinical research, patient oriented research, and research education
support. We will engage at the local, State, and Federal levels and
coordinate efforts with other professional organizations.
ACTS will promote investigations and dissemination of effective
models for mentoring future generations of translational scientists.
Through collaborative efforts, ACTS will provide a forum for members to
share studies, promote best practices, and optimize professional
relationships among trainees and mentors.
The Clinical Research Forum (CRF)
CRF was formed in 1996 to discuss unique and complex challenges to
clinical research in academic health centers. Over the past decade, it
has convened leaders in clinical research annually and has provided a
forum for discussing common issues and interests in the full spectrum
of research. Through its activities, the Forum has enabled sharing of
best clinical practices and increasingly has played a national advocacy
role in support of the boarder interests and needs of clinical
research.
Governed by a Board of Directors constituted of clinical
researchers from thirteen member institutions, CRF has grown to sixty
members from academia, industry, and volunteer health organizations.
CRF engages leaders in the clinical research enterprise including
leaders from government, foundations, other not-for-profit
organizations, and industry in addressing the challenges and
opportunities facing the clinical research enterprise.
Parallel with our widening focus upon the broad needs of the entire
national clinical research enterprise, CRF is committed to working in
those areas where it is uniquely positioned to have a significant
impact. Collaboration with other organizations with similar goals and
synergizing with their efforts strengthens all approaches to the issues
facing clinical research.
sequestration
Thank you for providing sequestration relief in fiscal year 2014
and fiscal year 2015.
Federal medical research programs form the cornerstone of our
Nation's biotech sector. In addition to undermining active and emerging
research projects, across the board funding cuts create widespread
disruption. Due to a number of factors, this disruption compounds
significant challenges facing the clinical and translational research
training and career development pipeline.
Recent years of near-level funding have curtailed NIH's ability to
issue funding opportunities. As a result, the pay line at NIH has
decreased substantially while the average age of an investigator
receiving their first award has increased significantly. This dynamic
creates a strong disincentive for young people to pursue a career in
this field. Prior to sequestration, NIH would often discuss the decline
in young investigators entering the research training and career
development pipeline.
Beyond public health, our country needs to ensure that we are
adequately preparing the next generation of medical investigators for
reasons related to both the economy and national security. Last year,
China announced a $300 billion 5-year investment in medical research;
this amount is double the current NIH budget over the same period of
time. With strong competition from foreign countries, we run the risk
of a researcher brain-drain from the U.S. to other Nations. Scientific
breakthroughs and innovation will continue, but our loss in this area
will mean gains for other Nations. Foreign economies will benefit from
the significant return-on-investment that occurs through robust support
of research.
Sequestration has the potential to severely exacerbate an already
difficult task of recruiting and training the next generation of
scientific investigators. In order to ensure that the U.S. maintains a
strong research training and career development pipeline, please
eliminate the threat of sequestration and further support key
activities.
national institutes of health
This Nation has a proud history as a global leader in medical
research and biotechnology. This leadership has provided our country
with cutting-edge patient care, high-quality jobs, and meaningful
economic growth. The Milliken Institute recently calculated that every
dollar invested in NIH returns about a $1.70 in economic output in the
short term and as much as $3.20 long-term. Crucially, through a robust
external research program, NIH resources flow out to the States where
the benefit of the funding infusion is felt on the local level.
NIH's impact on public health has been profound. Conditions once
considered a death-sentence can now be managed, survival rates for
patients with life-threatening diseases have increased dramatically,
and additional innovative therapies and diagnostic tools come to market
each year. NIH has been successful, but much more can be done. Please
provide NIH with at least $32 billion in fiscal year 2015 so ongoing
research projects can be adequately supported and new research
activities can be initiated.
Clinical and Translational Science Awards (CTSA)
NIH's CTSA Program, which is housed within the National Center for
Advancing Translational Sciences (NCATS), is transforming the
efficiency and effectiveness of clinical and translational research.
Since its establishment with 13 centers, the CTSA program has expanded
to 62 medical research institutions located across the country. These
centers are linked together and work in concert to improve human health
by energizing the research and training environment to innovate and
enhance the quality of clinical and translational research.
Last year, the Institute of Medicine (IOM) released a review of the
CTSA program. The report entitled, The CTSA Program at NIH:
Opportunities for Advancing Clinical and Translational Research, spoke
favorably of the CTSA effort and made the following recommendations to
improve the program:
(1) Strengthen NCATS leadership of the CTSA program, (2)
reconfigure and streamline the CTSA Consortium, (3) build on the
strengths of individual CTSAs across the spectrum of clinical and
translational research, (4) formalize and standardize evaluation
processes for individual CTSAs and the CTSA Program, (5) advance
innovation in education and training programs, (6) ensure community
engagement in all phases of research, (7) strengthen clinical and
translational research relevant to child health.
CCTS supports the recommendations of the IOM report and the
organization is hopeful these changes will be implemented quickly.
Further, when the CTSA program was authorized, Congress indicated that
the consortium would be considered fully-funded when it received an
annual appropriation of $750 million. For fiscal year 2015, as part of
an overall funding increase for NIH, please provide CTSAs with at least
$500 million to ensure the program can continue to grow and advance.
Additionally, we hope you will continue working over the coming years
to provide CTSAs with $750 million to fully fund the program and
establish a robust home for clinical and translational research.
Additional Programs
In recent years, Congress and NIH have made important investments
to support the full spectrum of medical research. Key clinical and
translational research programs at NIH include Research Centers at
Minority Institutions (RCMI), Institutional Development Awards (IDeA),
and the new Accelerating Medicine Partnership (AMP). Supporting the
full spectrum of medical research encourages outcomes-oriented
investigation where breakthroughs in basic science are translated to
new diagnostic tools and treatments that improve health and lower
healthcare expenses. In recognition of the future of the overall field
of medical research, most individual NIH Institutes and Centers now
provide some level of support for translational and clinical research
activities.
In order to ensure that clinical and translational research
programs at NIH have adequate support to facilitate ongoing growth,
please provide $32 billion for NIH in fiscal year 2015 with
proportional increases for individual Institutes, Centers, and Offices.
federal research training and career development programs
As we discussed previously, the future of our Nation's biomedical
research enterprise relies heavily on the maintenance and continued
recruitment of promising young investigators. The ``T'' and ``K''
series awards at NIH and AHRQ provide much-needed support for the
career development of young investigators. As clinical and
translational medicine takes on increasing importance, there is a great
need to grow these programs. Career development grants are crucial to
the recruitment of promising young investigators, as well as to the
continuing education of established investigators. Reduced commitment
to the K and T awards would have a devastating impact on our pool of
highly trained clinical researchers. CCTS urges you to support the
ongoing commitment to research training through adequate funding for T
and K series awards and a meaningful fiscal year 2015 funding increase
for AHRQ.
Thank you for the opportunity to present the views and
recommendations of the clinical and translational research and research
training and career development community.
______
Prepared Statement of the Coalition for Usher Syndrome Research
My name is Mark Dunning from the State of Massachusetts. As
Chairman of the Coalition for Usher Syndrome Research, I am here on
behalf of the Usher syndrome community to respectfully request this
committee encourage NIH to prioritize research that will eventually
expand treatment options for individuals suffering from the severe
hearing and vision loss related to Usher syndrome. We also respectfully
request that the committee direct NIH to move expeditiously to direct
additional resources to respond to any deficiencies in the funding
level or the manner in which various ICs coordinate on common goals and
objectives related to Usher syndrome.
Usher syndrome is the leading cause of deaf-blindness. In the
United States, it is estimated that about 45,000 people have this rare
genetic disorder. My fifteen year old daughter Bella is one of them.
She has Usher syndrome type 1b. She was born profoundly deaf and now
she is losing her vision to retinitis pigmentosa. She also suffers from
the severe balance issues common in her type of Usher syndrome.
Imagine yourself as a fifteen year old girl. Adulthood stands
before you. You dream of getting your driver's license, of the freedom
it provides, of the limits it removes. We live in a small town. There
is no public transportation. A car is the only way to get to work, to
visit friends, to shop for food. But Bella's vision is too poor for
driving. How will she survive?
Or imagine yourself as a sophomore in high school. You dream of
college, of the freedom it provides, of the limitless career
opportunities. Only hard work and desire stand between you and your
dreams. Unless, like Bella, you have Usher syndrome. Then you also face
the barriers of access to information. You cannot hear the professor or
see the board as well as your peers. You work many times harder to get
the same grades. And some trades are closed to you before you start.
Can you be an architect if you are losing your vision? Can you be a
salesperson if you have no hearing? Can you dare to dream of an
unfettered future? Is the American dream available to you if you have
Usher syndrome?
My daughter is an asset to this country. She is kind and
empathetic. She puts all others before herself. She is hard working and
fearless. She has been honored with a John F. Kennedy award for
leadership and a StayClassy award for philanthropy. She is the type of
fifteen year old we should be grooming as a future leader in the
country.
But Bella has Usher syndrome. She was born profoundly deaf and she
is going blind. She will fight it every step of the way, but without
increased Federal funding, she will eventually lose. And when Bella
loses, we all lose. Kids like Bella are our future. Unless they have
Usher syndrome. Then they are not, and we are all the worse for it.
People with Usher syndrome share the same range of intelligence and
work ethic as any other slice of America. Yet they suffer from an 82
percent unemployment rate. People with Usher syndrome are born with the
same emotional strength as any other American. Yet they have a suicide
rate that is 2\1/2\ times greater than the general population. People
with Usher syndrome not only have the capacity to contribute to
America's future, they thirst for it. They want to be active members of
society. Yet our country spends an estimated $139 billion annually in
direct and indirect costs for people with eye disorders and vision
loss.\1\ That doesn't even include the costs associated with hearing
impairment.
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\1\ Wittenborn, John S. & Rein, David B. ``Cost of Vision Problems:
The Economic Burden of Vision Loss and Eye Disorders in the United
States.'' NORC at the University of Chicago. Prepared for Prevent
Blindness America, Chicago, IL. June 11, 2013.
http://costofvision.preventblindness.org.
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In my role as the Chairman of the Coalition for Usher Syndrome
Research, I have spoken with or met hundreds of people who are
determined, focused, and working everyday to help themselves, their
loved one, or in some cases complete strangers, figure out how to treat
this syndrome. Usher genes are complex, long protein cells which
require significant investment in research if we are ever to find a
cure or treatment. We can't do it alone.
Through the Coalition, we have brought the Usher community and
researchers together by:
--Establishing a registry of individuals with Usher syndrome which is
available for research or clinical trials at no cost. Our
registry currently has families from each of the 50 States and
29 countries.
--Sponsoring an International Symposium on Usher Syndrome at the
Harvard Medical School in July 2014 to develop a roadmap for
future research projects to bring us closer to viable clinical
trials.
--Sponsoring annual family conferences, webinars and monthly
conferences that provide information and support to all of
those living with Usher.
With this in place, we have begun bringing brilliant researchers
together who are working on developing treatments every day.
Researchers like those in Oregon and Pennsylvania who are working on
gene therapy treatments, one of which began clinical trials last year.
Researchers in Louisiana, who have been able to rescue the hearing in
mice with Usher syndrome using a drug therapy that holds promise for
rescuing vision as well. Researchers in Iowa, California, Nebraska,
Massachusetts, Florida, Texas, and many other States, who are
collaborating with each other and with families through the Coalition
to advance all kinds of Usher syndrome research.
But still this is not enough. We cannot help any of the tens of
thousands who have Usher, or countless others that will be born in the
future with this devastating genetic disorder without Federal support.
There are dozens of different mutations that cause Usher syndrome, and
the pace of research is slowed dramatically by the lack of researchers
and funding. The infrastructure is there to find treatments, but the
significant financial support is not. We are asking you to supply this
last critical resource to help us find a cure.
When you review the report on categorical spending by the NIH,
Usher syndrome is not even listed. Rare diseases with similar incident
rates average around $50 million annually. These investments have
resulted in significant discoveries for these diseases and there is
reason to believe that we can see these same results or better for
Usher syndrome. We do not ask that the committee throw dollars at the
problem. Only that they ensure the appropriate funding is available.
The researchers are there, waiting to discover what now is just a
dream. All we are asking for is a chance; a chance for deaf children
and adults who are going blind, a chance to see. With your help, my
daughter and others like her can once again dare to dream.
I will leave you with the words of America's most famous deaf-blind
person, Helen Keller. ``Alone we can do so little; together we can do
so much.'' Only together can we find a way to end deaf-blindness. I
thank you on behalf of all those with Usher syndrome, their families,
and most importantly to me, my daughter Bella.
[This statement was submitted by Mark Dunning, Chairman, Coalition
for Usher Syndrome Research.]
______
Prepared Statement of the Coalition of Northeastern Governors
The Coalition of Northeastern Governors (CONEG) is pleased to share
with the Subcommittee on Labor, Health and Human Services, Education,
and Related Agencies its views regarding the fiscal year 2015
appropriations for the Low-Income Home Energy Assistance Program
(LIHEAP).
The CONEG Governors appreciate the Subcommittee's long-standing
support for this vital program, and recognize the difficult fiscal
decisions that face the Subcommittee. In recognition of the on-going
challenges that the most vulnerable low-income households in our region
face in heating their homes, the Governors urge the Subcommittee to
fund the LIHEAP core block program in fiscal year 2015 at the
authorized level of $5.1 billion but not less than $4.7 billion. In
addition, the Governors request sufficient contingency funds to address
unforeseen energy emergencies such as prolonged severe weather or price
spikes in home heating fuels. Adequate, predictable and timely Federal
funding is essential for LIHEAP to provide a vital lifeline to those
households struggling to afford the basic necessity of home energy. The
Governors urge the Subcommittee to provide these funds in a manner
consistent with the LIHEAP statutory objective: ``to assist low-income
households, particularly those with the lowest incomes that pay a high
proportion of household income for home energy, primarily in meeting
their immediate home energy needs.''
LIHEAP funds are targeted to those households with the greatest
energy burden. Most LIHEAP assistance is targeted to households whose
income is less than 150 percent of the Federal poverty level, which for
a two-person household is $23,595 in 2014. However the majority of
LIHEAP recipients have incomes far below that level. Many of these
households live on fixed incomes and are not likely to benefit from
improvements in the job market and the national economy. More than
ninety percent of LIHEAP households have at least one vulnerable
member--the elderly or disabled and young children--for whom
temperature extremes could have serious health and safety consequences.
Approximately 20 percent of LIHEAP households contain at least one
member who is a military veteran.
Low-income households across the Nation spend a disproportionate
amount of their income on home energy, often over three times more than
non-low-income households. The AARP estimates low-income senior
households (age 65 and older) heating with fuel oil will spend almost
20 percent of household income on heating costs, while all other
households heating with fuel oil will spend roughly 5 percent of their
income to heat their homes. In the colder climates of the Northeast,
the average household typically uses 800 gallons of heating oil per
winter. At EIA's projected average cost of $3.83 per gallon, an elderly
LIHEAP recipient whose primary income is a Social Security check would
need to spend almost 3 months of income to heat her home this winter.
Many seniors will spend more than one-third of their monthly income
just to get the minimum 100-gallon delivery of heating oil.
The energy burden faced by low-income households is particularly
acute in the Northeast. This region experiences some of the Nation's
highest home heating bills due to a combination of the extended winter
heating season and heating fuel expenditures that typically exceed
national averages. According to the Energy Information Administration
(EIA), the average consumer expenditures for heating fuels in the
Northeast have consistently and significantly exceeded similar
expenditures in all other regions regardless of the type of fuel used--
natural gas, heating oil, propane, or electricity.
Low-income households in the Northeast experience another aspect of
``energy burden''. More than any other region of the country, Northeast
households are dependent upon delivered fuels--heating oil, propane and
kerosene. The 30 percent of Northeast households that rely upon
delivered fuels account for approximately 80 percent of the homes
nationwide that use home heating oil. These heating fuels are also the
most expensive and volatile in price. The EIA estimates that households
using heating oil can expect to pay $2,243 to keep warm this winter.
The EIA also finds that households using delivered fuels see any change
in wholesale prices reflected in their energy bills almost immediately,
unlike natural gas and electricity retail customers. These ``delivered
fuel'' households experience another vulnerability compared to natural
gas and electricity customers. Low-income households that use delivered
fuels are less likely to have the option of payment plans, access to
utility assistance programs, and the protection of utility service
shut-off moratoria during the heating season. If LIHEAP funds are not
available to these households, the fuel delivery truck simply does not
come.
The Northeast has some of the country's oldest homes and coldest
climates. Reducing home energy costs presents unique challenges to
northeast states. State LIHEAP programs, often working with their
Weatherization Assistance Programs, help low-income households take
steps to reduce their energy use and lower their energy bills. Unlike
the Federal weatherization program, LIHEAP funds can be used to provide
repair or replace inefficient, unsafe and non-working home heating
systems--improvements that enhance the safety and reduce the energy use
of low-income households.
Even with these programs to reduce energy use, many of the lowest
income families that benefit from LIHEAP have limited options to reduce
their energy bills. Some older homes, especially older manufactured
homes, have structural issues that make them ineligible for
weatherization assistance. Throughout the region, many LIHEAP
households have limited ability to switch to more energy efficient
heating systems due to the lack of adequate resources for the upfront
costs and the lack of access to less expensive heating fuels. For
example, natural gas may provide a less expensive energy source to heat
homes, but conversion is neither simple nor affordable for low-income
households. The New England Fuel Institute estimates that converting a
complete home heating system from oil to natural gas can cost as much
as $10,000. In addition, homes in rural and metropolitan areas
throughout the Northeast are not served by natural gas infrastructure.
State LIHEAP programs continue to seek innovative and efficient
ways to ``do more with less'' and stretch scarce LIHEAP dollars to
ensure that meaningful assistance can be provided to those households
with the greatest needs. For example, LIHEAP funds are frequently
leveraged by utility assistance programs for low-income households.
States in the Northeast have worked with utilities to develop payment
plans to reduce arrearages and lessen the prospect of utility shut-offs
after the heating season ends. They have negotiated with fuel dealers
to receive discounts on deliverable fuels, and have entered into
agreements to purchase fuel in the summer when prices are lowest.
LIHEAP is one of the most efficiently run programs with low overhead
costs. Even after taking significant cost-cutting steps, States have
had to take actions such as tightening program eligibility, closing the
program early, and reducing benefit levels.
In summary, the CONEG Governors appreciate the Subcommittee's
continued support for LIHEAP, and urge you to fund the core block grant
at the authorized level of $5.1 billion, but not less than $4.7
billion, and sufficient contingency funds to address unforeseen energy
emergencies.
______
Prepared Statement of the College on Problems of Drug Dependence
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to submit testimony to the Subcommittee in support of the
National Institute on Drug Abuse. The College on Problems of Drug
Dependence (CPDD), a membership organization with over 1000 members,
has been in existence since 1929. It is the longest standing group in
the United States addressing problems of drug dependence and abuse. The
organization serves as an interface among governmental, industrial and
academic communities maintaining liaisons with regulatory and research
agencies as well as educational, treatment, and prevention facilities
in the drug abuse field. CPDD also often works in collaboration with
the World Health Organization.
Recognizing that so many health research issues are inter-related,
we request that the subcommittee provide at least $32 billion for the
National Institutes of Health (NIH) and within that amount a
proportionate increase for the National Institute on Drug Abuse, in
your Fiscal 2015 Labor, Health and Human Services, Education and
Related Agencies Appropriations bill. We also respectfully request the
inclusion of the following NIDA specific report language.
Marijuana Research. Efforts to legalize or ``medicalize'' marijuana
continue across the United States. The Committee understands that
research from different areas of science is converging on the fact that
regular marijuana use by young people can have a long-lasting negative
impact on the structure and function of their brains, resulting in
lower educational achievement, reduced IQ, etc. Research clearly
demonstrates that marijuana has the potential to cause problems in
daily life or make a person's existing problems worse. NIDA is
encouraged to continue to fund research on preventing and treating
marijuana abuse and addiction, and the possible health and policy
implications of proposals to implement ``medical marijuana'' or
marijuana legalization programs across the U.S.
Opiate Abuse and Addiction. The Committee is concerned about the
continued crisis of prescription drug abuse in the U.S. In particular,
the June 2011 IOM report on pain indicates that abuse and misuse of
prescription opioid drugs resulted in an annual estimated cost to the
Nation of $72,500,000,000. Further, the Committee is very concerned
with the potential rise in heroin abuse and addiction as a result of
successful efforts to combat the prescription drug side of this issue.
The Committee urges NIDA to 1) continue funding research on medications
to alleviate pain, including the development of pain medications with
reduced abuse liability; 2) as appropriate, work with private companies
to fund innovative research into such medications; and 3) report on
what we know regarding the transition from opiate analgesics to heroin
abuse and addiction within affected populations.
Medications Development. The Committee recognizes that next-
generation pharmaceuticals will surely take advantage of new
technologies. In the context of NIDA funding, chief among these are
NIDA's current approaches to develop viable immunotherapeutic or
biologic (e.g., bioengineered enzymes) approaches for treating
addiction. The goal of this active area of research is the development
of safe and effective vaccines or antibodies that target specific
drugs, like nicotine, cocaine, and heroin, or drug combinations. The
Committee is excited by this approach--if successful, immunotherapies,
alone or in combination with other medications, behavioral treatments,
or enzymatic approaches, stand to revolutionize how we treat, and,
maybe even someday, prevent addiction. The Committee looks forward to
hearing more about work in this area.
Nurturing Talent and Innovation in Research. The Committee commends
NIDA for its continued support of innovative research on drug addiction
and related health problems such as pain and HIV/AIDS, and the
Institute's effort to be at the forefront of training the next
generation of innovative researchers. The 6 year-old Avant-Garde award
is a good example of a program that stimulates high-impact research
that could lead to groundbreaking opportunities for the prevention and
treatment of HIV/AIDS in drug abusers. The Committee understands that
NIDA is now crafting a new kind of award, which would blend NIH's
Pioneer and New Innovator award mechanisms. This new opportunity,
called ``AVENIR'' awards, is designed to attract creative young
investigators into HIV/drug abuse public health research. The Committee
strongly supports this effort, and asks the Institute to report on its
progress in future appropriations and related requests.
Research to Assist Military Personnel, Veterans, and Their
Families. The Committee recognizes the significant health challenges,
including substance abuse and addiction, faced by military personnel,
veterans, and their families. Many of these individuals need help
confronting war-related problems including traumatic brain injury,
PTSD, depression, anxiety, sleep disturbances, and substance abuse and
addiction. The Committee commends NIDA for its successful efforts to
coordinate and support research with the Department of Veterans
Affairs, Department of Defense, and other NIH Institutes focusing on
these populations, and strongly urges NIDA to continue work in this
area.
Raising Awareness and Engaging the Medical Community in Drug Abuse
and Addiction Prevention and Treatment. The Committee is very pleased
with NIDAMed, an initiative designed to reach out to physicians,
physicians in training, and other healthcare professionals. The
Committee urges the Institute to continue its focus on activities to
provide physicians and other medical professionals with the tools and
skills needed to incorporate drug abuse screening and treatment into
their clinical practices.
Drug abuse is costly to Americans; it ruins lives, while tearing at
the fabric of our society and taking a huge financial toll on our
resources. Beyond the unacceptably high rates of morbidity and
mortality, drug abuse is often implicated in family disintegration,
loss of employment, failure in school, domestic violence, child abuse,
and other crimes. Placing dollar figures on the problem; smoking,
alcohol and illegal drug use results in an exorbitant economic cost on
our Nation, estimated at over $600 billion annually. We know that many
of these problems can be prevented entirely, and that the longer we can
delay initiation of any use, the more successfully we mitigate future
morbidity, mortality and economic burdens.
Over the past three decades, NIDA-supported research has
revolutionized our understanding of addiction as a chronic, often-
relapsing brain disease --this new knowledge has helped to correctly
situate drug addiction as a serious public health issue that demands
strategic solutions. By supporting research that reveals how drugs
affect the brain and behavior and how multiple factors influence drug
abuse and its consequences, scholars supported by NIDA continue to
advance effective strategies to prevent people from ever using drugs
and to treat them when they cannot stop.
NIDA supports a comprehensive research portfolio that spans the
continuum of basic neuroscience, behavior and genetics research through
medications development and applied health services research and
epidemiology. While supporting research on the positive effects of
evidence-based prevention and treatment approaches, NIDA also
recognizes the need to keep pace with emerging problems. We have seen
encouraging trends--significant declines in a wide array of youth drug
use--over the past several years that we think are due, at least in
part, to NIDA's public education and awareness efforts. However, areas
of significant concern include the recent increase in lethalities due
to heroine, as well as the continued abuse of prescription opioids and
the recent increase in designer drugs availability and their
deleterious effects. The need to increase our knowledge about the
effects of marijuana is most important now that decisions are being
made about its approval for medical use and/or its legalization. We
support NIDA in its efforts to find successful approaches to these
difficult problems.
The Nation's previous investment in scientific research to further
understand the effects of abused drugs on the body has increased our
ability to prevent and treat addiction. As with other diseases, much
more needs be done to improve prevention and treatment of these
dangerous and costly diseases. Our knowledge of how drugs work in the
brain, their health consequences, how to treat people already addicted,
and what constitutes effective prevention strategies has increased
dramatically due to support of this research. However, since the number
of individuals continuing to be affected is still rising, we need to
continue the work until this disease is both prevented and eliminated
from society.
We understand that the fiscal year 2015 budget cycle will involve
setting priorities and accepting compromise, however, in the current
climate we believe a focus on substance abuse and addiction, which
according to the World Health Organization account for nearly 20
percent of disabilities among 15-44 year olds, deserves to be
prioritized accordingly. We look forward to working with you to make
this a reality. Thank you for your support for the National Institute
on Drug Abuse.
______
Prepared Statement of the Consortium of Social Science Associations
Mr. Chairman and Members of the Subcommittee, the Consortium of
Social Science Associations (COSSA) appreciates and welcomes the
opportunity to comment on the fiscal year 2015 appropriations for the
National Institutes of Health (NIH), Centers for Disease Control and
Prevention (CDC) and the Agency for Healthcare Research and Quality
(AHRQ). COSSA joins the Ad Hoc Group for Medical Research in
recommending that NIH receive at least $32 billion in fiscal year 2015
as the next step toward a multi-year increase in our Nation's
investment in medical research. As a member of the CDC Coalition, COSSA
requests $7.8 billion in funding for the CDC in fiscal year 2015. We
join the Friends of AHRQ in requesting a funding level of $375 million
for AHRQ in fiscal year 2015.
COSSA is an advocacy group for the social and behavioral sciences
supported by more than 100 professional associations, scientific
societies, universities and research centers. It serves as a bridge
between the academic research and Washington policy-making community.
Our organizations are appreciative of the Subcommittee's and the
Congress' continued support of NIH, CDC, and AHRQ. Strong, sustained
funding for these agencies is essential to the national priorities of
better health and economic revitalization.
nih behavioral and social sciences research
As this Committee knows, the NIH mission is to support
scientifically rigorous, peer/merit-reviewed, investigator-initiated
research, including basic and applied behavioral and social science
research in fulfilling its mission: ``Science in pursuit of fundamental
knowledge about the nature and behavior of living systems and the
application of that knowledge to enhance health, lengthen life and
reduce illness and disability.''
The fundamental understanding of how disease works, including the
impact of social environment on these disease processes, underpins our
ability to conquer devastating illnesses. Perhaps the grandest
challenge we face is to understand the brain, behavior, and society--
from responding to short-term pleasures to self-destructive behavior,
such as addiction, to lifestyle factors that determine the quality of
life, infant mortality rate and longevity. And while Americans have
achieved very high levels of health over the past century and are
healthier than people in many other Nations, according to the 2013
National Academies' (NAS) report, U.S. Health in International
Perspective: Shorter Lives, Poorer Health, ``a growing body of research
suggests that the health of the U.S. population is not keeping pace
with the health of people in other economically advanced, high-income
countries.''
Nearly 125 million Americans are living with one or more chronic
conditions, including heart disease, cancer, diabetes, kidney disease,
arthritis, asthma, mental illness and Alzheimer's disease. At the same
time, healthcare spending in the United States is being driven up by
the aging of the U.S. population and the rapid rise in chronic
diseases, many of which are caused or exacerbated by behavioral
factors--including, obesity, caused by sedentary behavior and poor
diet, and addictions resulting from health problems caused by tobacco
and other drug use. As the NAS report notes, ``the United States is
losing ground in the control of diseases, injuries, and other sources
of morbidity.''
The behavioral and social sciences regularly make important
contributions to the well-being of this Nation. Due in large part to
the behavioral and social science research sponsored by the NIH, we are
now aware of the enormous role behavior plays in our health. At a time
when genetic control over disease is tantalizingly close but not yet
possible, knowledge of the behavioral influences on health is a crucial
component in the Nation's battles against the leading causes of
morbidity and mortality: obesity, heart disease, cancer, AIDS,
diabetes, age-related illnesses, accidents, substance abuse, and mental
illness.
As a result of the strong Congressional commitment to the NIH in
years past, our knowledge of the social and behavioral factors
surrounding chronic disease health outcomes is steadily increasing. The
NIH's behavioral and social science portfolio has emphasized the
development of effective and sustainable interventions and prevention
programs targeting those very illnesses that are the greatest threats
to our health, but the work is just beginning. This includes NIH's
support of economic research, specifically, research on the linkages
between socioeconomic status and health outcomes in the elderly and
achievement and health outcomes in children. This research has been an
integral part of the interdisciplinary science NIH has historically
supported. Accordingly, the agency's investment has yielded key data,
methodologies and substantive insights on some of the most important
and pressing issues facing the U.S. For example, NIH-funded surveys
such as the Health and Retirement Survey, the Panel Study of Income
Dynamics (PSID), parts of the National Longitudinal Survey of Labor
Market Experiences, and surveys on international aging and retirement
provide data necessary to monitor and detect changes in important
socioeconomic trends in health. This in turn allows NIH to support
research that will provide the greatest return on its investment when
it comes to the health of our citizens.
cdc behavioral and social science research
As the country's leading health protection and surveillance agency,
the Centers for Disease Control and Prevention (CDC) works with State,
local, and international partners to protect Americans from infectious
diseases; prevent the leading causes of disease, disability, and death;
protect Americans from natural and bioterrorism threats; monitor health
and ensure laboratory excellence; keep Americans safe from
environmental and work-related hazard; and ensure global disease
protection.
Social and behavioral science research plays a crucial role in
helping the CDC carry out its mission. Scientists in fields ranging
from psychology, sociology, anthropology, and geography to health
communications, social work, and demography work in every CDC Center to
design, analyze, and evaluate behavioral surveillance systems, public
health interventions, and health promotion and communication programs
using a variety of both quantitative and qualitative methods. These
scientists play a key role in the CDC's surveillance and monitoring
efforts, which collect and analyze data to better target public health
prevention efforts. Another vital contribution of the social and
behavioral sciences to CDC activities is in identifying and
understanding health disparities. Finally, the social and behavioral
sciences play an important role in the evaluation of CDC programs,
helping policymakers make informed, evidence-based decisions on how to
prioritize in a resource-scarce environment.
The CDC is also the home of the Nation's principal health
statistics agency, the National Center for Health Statistics (NCHS).
NCHS collects data on chronic disease prevalence, healthcare
disparities, emergency room use, teen pregnancy, infant mortality,
causes of death and rates of insurance, to name a few. It provides
critical data on all aspects of our healthcare system through data
cooperatives and surveys that serve as the gold standard for data
collection around the world. Data from NCHS surveys like the National
Health Interview Survey (NHIS), the National Health and Nutrition
Examination Survey (NHANES) and the National Vital Statistics System
(NVSS) are used by agencies across the Federal Government, State and
local governments, public health officials, Federal policymakers, and
demographers, epidemiologists, health services researchers, and other
scientists.
ahrq health services research
AHRQ's sole purpose is to improve healthcare in America. Just as
biomedical research helps us find cures for disease, the health
services research AHRQ supports helps find ways to cure our healthcare
system--improving its quality, safety, and efficiency for the benefit
of patients. AHRQ's research identifies what works and what doesn't in
healthcare to improve patient care and provide policymakers and other
healthcare leaders with the information needed to make critical
healthcare decisions.
AHRQ helps providers help patients. AHRQ's research generates
valuable evidence to help providers help patients make the right
healthcare decisions for themselves and their loved ones. The science
funded by AHRQ ensures patients receive high quality, appropriate care
every time they walk through the hospital, clinic, and medical office
doors. AHRQ's research provides the basis for protocols that prevent
medical errors and reduce healthcare-associated infections (HAIs), and
improve patient experiences and outcomes. AHRQ helps healthcare
providers--from private practice physicians to large hospital systems--
understand how to deliver the best care most efficiently. The breadth
of evidence available from AHRQ empowers healthcare providers to
understand not just how they compare to their peers, but also how to
improve their performance to be more competitive.
COSSA expects this testimony to be only the beginning of an ongoing
conversation between the Subcommittee and stakeholders on the fiscal
year 2015 funding needs of these agencies.
We would be pleased to provide any additional information.
______
Prepared Statement of the Corporation for Public Broadcasting
Chairman Harkin and distinguished members of the subcommittee,
thank you for allowing me to submit this testimony on behalf of
America's public media service--public television and public radio--on-
air, online and in the community. The Corporation for Public
Broadcasting (CPB) requests level funding of $445 million for fiscal
year 2017 and $27.3 million for the Department of Education's Ready To
Learn program in fiscal year 2015.
Forty-six years after passage of the Public Broadcasting Act, this
uniquely American public-private partnership is keeping its promise to
the American people by providing a safe place where children can learn
on-air and online; providing high-quality educational content for
teachers in the classroom and children schooled at home; providing
reliable and trusted news and information; and providing emergency
alert services. Either by looking at each station individually or
public media as a whole, this public-private partnership is making a
big difference in the lives of individuals and communities.
Today we are a system that comprises more than 1,400 locally owned
and locally operated public radio and television stations serving rural
and urban communities throughout the country. More than 98 percent of
the American people turn to American public media for high quality
content that educates, informs, inspires and entertains. Public media's
commitment to early and lifelong learning, available to all citizens,
helps strengthen our civil society and our democracy. Our trusted,
noncommercial services available for free to all Americans is
especially important to those living in rural communities where the
local public media station is sometimes the only source of broadcast
news, information and educational programming.
I understand that this committee is faced with the challenging task
of allocating scarce Federal resources to a number of organizations,
all doing worthy and important work. The financial support for the
public broadcasting system that is derived from the Federal
appropriation is the essential investment keeping public media free and
commercial free for all Americans. Former President Ronald Reagan said,
``Government should provide the spark and the private sector should do
the rest.'' And what stations do, with the spark of Federal dollars
that amounts to approximately 10 to 15 percent of a stations' budget,
results in a uniquely entrepreneurial and American public media system
with a track record of proven benefits delivered through stations to
the American people.
The Federal investment through CPB is the foundation on which the
entire system is built. These critical funds leverage vital investments
from other sources. Undermining this foundation would put the entire
structure in jeopardy. While private donations and existing funding
sources can help defray considerable costs for the much-honored
programs of public television and radio--nonFederal funding represents
five of every six dollars invested annually in public broadcasting--the
Federal investment is indispensable to sustaining the operations of
public broadcasting stations, the public service mission they pursue,
local community-based accountability, and the universal service to
which the Public Broadcasting Act aspires.
Further, it is this initial investment in public media that keeps
it commercial free and available to all Americans for free. However,
smaller stations serving rural, minority and other underserved
communities are hard pressed to raise six times the Federal
appropriation, which can represent as much as 40 percent of their
budget.
Public media's contribution to education--from early childhood
through adult learning--is well documented. We are America's largest
classroom, with proven content available to all children, including
those who cannot afford preschool. Our content is repeatedly regarded
as ``most trusted'' by parents, caregivers and teachers.
CPB's work with the Department of Education's Ready To Learn
program is an excellent example of how public media brings together
high-quality educational content with on-the-ground work in local
communities. We also invest in research that demonstrates and promotes
the effectiveness of this content in formal and informal educational
settings.
We talk a lot about content that matters and engagement that
counts, further defining public media from commercial media. An example
of this is CPB's ``American Graduate: Let's Make it Happen''
Initiative, which tells the story behind the statistic of one million
American young people failing to graduate every year from high school.
Our stations told the stories and communities throughout the country
responded. More than 75 public media stations located in 33 States with
at-risk communities are working with more than 1000 national and
community-based partners to bring together diverse stakeholders and
community organizations; filling gaps in information, resources and
solutions; sharing best practices for teacher training and student
engagement; creating local programming around the dropout issue unique
to their communities, and leveraging digital media and technology to
engage students in an effort to keep them on the path to graduation.
Those numbers are now declining because what our stations do, counts.
But American Graduate is just one example of how public media stations
are using their spectrum for the public good.
Building on our education commitment, CPB recently announced that
it will expand on these successful models to bring meaningful impact
and change to more communities at risk. Through the recently created
$20 million American Graduate/PBS KIDS Fund, CPB and PBS will invest in
the development of new tools to help parents better prepare their
children ages 2-8 for educational success, to support teacher
development, and to engage middle and high school youth to improve
learning.
Public media is utilizing today's technology to provide content of
value to millions of citizens who trust us to deliver content that
matters and is relevant to their lives today. CPB strategically focuses
investments through the lens of what we refer to as the ``Three D's''
--Digital, Diversity and Dialogue. This refers to support for
innovation on digital platforms, extending public media's reach and
service over multiple platforms; content that is for, by and about
Americans of all backgrounds; and services that foster dialogue between
the American people and the public service media organizations that
serve them.CPB funding enables stations to provide content of
consequence and to keep faith with the visions of political,
educational, philanthropic and community leaders who have seen in
public broadcasting the potential to strengthen our nation by promoting
lifelong learning and an informed citizenry.
As the steward of these important taxpayer dollars, CPB ensures
that 95 cents of every dollar received goes to support local stations
and the programs and services they offer to their communities; no more
than five cents of every dollar goes to the administration of funding
programs and overhead.
The Public Broadcasting Act ensures diversity in this programming
by requiring CPB to fund independent and minority producers. CPB
fulfills this obligation, in part, by funding the Independent
Television Service, the five Minority Consortia entities in television
(African American, Latino, Asian American, Native American and Pacific
Islander), several public radio consortia (Latino Public Radio
Consortia, African American Public Radio Stations, and Native Public
Media) and numerous minority public radio stations. In addition, CPB,
through its Diversity and Innovation fund, makes direct investments in
the development of diverse primetime and children's broadcast programs
as well as innovative digital content.
As newspapers across the country have scaled back their operations,
public media has stepped into the void. Local stations have been
working to fill the gap with creative ventures and partnerships, such
as our seven multimedia local journalism centers (LJCs) that are
providing their communities with much-needed local, regional and
statewide coverage.
For an investment of approximately $1.35 per American per year,
public media stations are able to train teachers and help educate
America's children; provide in-depth journalism that informs citizens
about issues in their neighborhoods, their country, and around the
globe; make the arts accessible to all Americans; and provide emergency
alert services for their communities.
CPB's fiscal year 2017 request of $445 million balances the fiscal
reality facing our nation with our statutory mandate to provide a
valuable and trusted service to all Americans. Today, the challenges we
face are more complex than ever and require new levels of thinking,
innovation, and collaboration. Community organizations often work in
isolation, shouldering the burden of solving societal problems. But
public media is the essential link, uniquely poised to add real value.
CPB's fiscal year 2017 request will allow stations to enhance their
role as a trusted source of information and as a convener, help
communities understand issues, and mobilize them toward positive,
sustainable outcomes.
Mr. Chairman and members of the subcommittee, this is only part of
the story of our public media system in America. Public media is a
national treasure that is available and accessible to all Americans.
Every day public media works to strengthen and advance our civil
society. I thank you for allowing me to submit this testimony and urge
you to consider our request for funding.
[This statement was submitted by Patricia Harrison, President and
CEO, Corporation for Public Broadcasting.]
______
Prepared Statement of Council of Academic Family Medicine
We urge the Committee to appropriate at least $71 million for the
health professions program, Primary Care Training and Enhancement,
authorized under Title VII, Section 747 of the Public Health Service
Act, under the jurisdiction of the Health Resources and Services
Administration (HRSA.) In addition, we recommend the Committee fund the
Agency for Healthcare Research and Quality (AHRQ) at no less than $375
million in base discretionary funding to support research vital to
primary care.
The member organizations of the Council of Academic Family Medicine
(CAFM) are pleased to submit testimony on behalf of programs under the
jurisdiction of the Health Resources and Services Administration (HRSA)
and the Agency for Healthcare Research and Quality (AHRQ). The programs
we support in our testimony are ones that deliver an investment in our
Nation's workforce and health infrastructure. They are a down payment
on a U.S. healthcare system with a foundation of primary care that will
produce better health outcomes and reduce the ever rising costs of
healthcare. We understand that hard decisions must be made in these
difficult fiscal times, but even in this climate, we hope the Committee
will recognize that the production of a robust primary care workforce
for the future is a necessary investment that cannot wait and will
ultimately produce long term savings.
Primary Care Training and Enhancement
The Primary Care Training and Enhancement Program (Title VII,
Section 747 of the Public Health Service Act) has a long history of
providing indispensable funding for the training of primary care
physicians. With each successive reauthorization, Congress has modified
the Title VII health professions programs to address relevant workforce
needs. The most recent authorization directs the Health Resources and
Services Administration (HRSA) to prioritize training in the new
competencies relevant to providing care in the patient-centered medical
home model. It also calls for the development of infrastructure within
primary care departments for the improvement of clinical care and
research critical to primary care delivery, as well as innovations in
team management of chronic disease, integrated models of care, and
transitioning between healthcare settings. Departments of family
medicine and family medicine residency programs often rely on Title
VII, Section 747, grants to help develop curricula and research
training methods for transforming practice delivery.
There has not been a competitive cycle for these grants since
fiscal year 2010. There are currently over 200 grants, completing their
cycle in fiscal year 2014 who will be eligible to apply in fiscal year
2015, as well as numerous other potential applicants who did not
receive funding in fiscal year 2010. The current funding level
(approximately $36.9 million) is not enough to allow for the pent up
demand. More importantly, the vital work of these grants to help reform
primary care education and the health delivery system needs to be
prioritized.
As implementation of the Affordable Care Act proceeds with
increasing numbers of insured persons, the Nation will need new
initiatives relating to increased training in inter-professional care,
the patient-centered medical home, and other new competencies required
in our developing health system. Such initiatives will be impossible to
implement without a competitive grant cycle with enough funding to
allow for a robust result of new grants. Now is the time to ensure that
critical funding for the Primary Care Training and Enhancement program
takes place. Title VII has a profound impact on States across the
country and is vital to the continued development of a workforce
designed to care for the most vulnerable populations and meet the needs
of the 21st century. We cannot allow the primary care pipeline to dry
up.
Below are some examples of how these grants have made lasting
contributions:
``With funding from a Title VII Medical Student Education grant, we
were able to expand our existing medical student family medicine
clerkship clinic to include students from pharmacy, nursing,
occupational and physical therapy, and law, who see patients together
under the supervision of faculty from all disciplines. This has allowed
us to create one of the few truly interprofessional clinical
experiences.'' Joshua Freeman, MD, Chair, Department of Family
Medicine, University of Kansas School of Medicine
``Our AAU HRSA Title VII Grant has allowed us to transform the
education of medical students and residents at Brown University around
the patient centered medical home, including new curricula and
rotations, as well as the facilitation work to transform 10 family
medicine teaching practices. In addition, we have run 3 national
``think tanks'' to discuss practical and theoretical issues related to
models for practice transformation, PCMH evaluation, and the Adolescent
PCMH. This grant has had huge impact and the work could not have been
done without it. Jeffrey Borkan, MD, PhD, Chair, Department of Family
Medicine, Brown University
``Previous grants included starting a resident continuity clinic at
an FQHC, and preparation for rural training (rural continuity clinic,
curriculum, rural mentoring program, rural medicine interest group).
More distant grants help set up rural training sites for medical
students and residents in 1975 and 1980, both of which are still
providing that important function. Steven C. Zweig, MD, MSPH, Chair,
Department of Family Medicine, University of Missouri''
``We have used HRSA funding to transform our curriculum and our
Family Medicine Center using the principles of PCMH. We have partnered
with a local income based elderly housing complex to provide clinical
services on-site. We have partnered with a community senior center to
provide on-site instruction to elderly community dwelling individuals.
We have added instruction in quality and safety throughout the
residency and using the PDSA cycle we improve care in asthma, asthma,
and hypertension as well as our preventive care. As a consequence we
have put ourselves in a position to become NCQA Level 3 certified by
December 31.'' In addition, we were able to partner with the local
FQHCs and create a longitudinal patient care track in the first 2 years
of medical school. Beginning October of the first year, the students
are placed in a primary care (and most in an underserved) site on an
ongoing, monthly basis. They are given the skills to be a member of the
care team and participate in all aspects of patient care.'' Allen
Perkins, MD, Professor and Chair, Department of Family Medicine,
University of South Alabama College of Medicine
``Title VII funding has allowed our residency site to implement an
interprofessional team-based care curriculum as part of our patient-
centered medical home transformation. Residents work with nurses,
social workers, nurse midwives, community health workers, nutritionists
and certified diabetes educators and learn about optimal team
communication and care for their patients through participation in
several group visit programs (centering pregnancy, well baby visits and
diabetes group visits). Their learning is also supplemented by a
longitudinal video feedback to improve doctor-patient communication,
which includes 360 degree feedback and preceptor training.'' Michelle
Roett, MD, MPH, FAAFP, Residency Program Director, Georgetown
University-Providence Hospital FMR, in Colmar Manor, MD
Agency for Health Care Research and Quality (AHRQ)
Two years ago, we were disappointed to see the subcommittee
eliminate funding for AHRQ in its draft bill. We understand that in our
current budgetary climate it is important to leverage research funding
in the most effective ways possible. However, the majority of research
funding supports research of one specific disease, organ system,
cellular, or chemical process--not for primary care. This is in spite
of the fact that the overall health of a population is directly linked
to the strength of its primary healthcare system. Primary care research
includes: translating science into the practice of medicine and caring
for patients, understanding how to better organize healthcare to meet
patient and population needs, evaluating innovations to provide the
best healthcare to patients, and engaging patients, communities, and
practices to improve health. AHRQ is uniquely positioned to support
this sort of best practice research and to help advance its
dissemination to improve primary care nationwide.
There are six areas that we believe AHRQ excels at--and that are
not available elsewhere in the biomedical research infrastructure:
primary care research through Practice-based Research Networks (PBRNs),
practice transformation, patient quality and safety in non-hospital
settings, multi-morbidity research, mental and behavioral health
provision in communities and primary care practices, and training
future primary care investigators. Critical to the successful
engagement and development of primary care research is the constraint
of not having an adequate cadre of well-trained researchers. We believe
there is a need to deliberately promote this training as a way to aid
in the development of all the areas we have emphasized. AHRQ has
researcher training mechanisms in place, which we believe are
important, and need to be expanded.
Some examples from the field regarding the utility of AHRQ-funded
grants:
``Three AHRQ grants supported the development of patient centered
personal health records in 2007, 2009, and 2010, and studied whether
these tools increased prevention. In our studies we found increases in
important tests like colon and breast cancer screening as well as
immunizations, blood pressure and cholesterol control. In addition, we
were able to leave the functionality in place--permanently--for 191
doctors and now 60,000 patients. One result is that the practices are
now using the AHRQ created portal as their sole patient portal and
abandoned the commercial portal that did not work as well.'' Alex
Krist, M.D., M.P.H., Virginia Commonwealth University
``The AHRQ-sponsored series of grants on Multiple Chronic Condition
research were transformative for that field. They also sponsored
regular meetings among grantees and established the Multiple Chronic
Conditions Research Network, which has fostered many collaborations
between researchers with shared expertise.'' Elizabeth A. Bayliss, MD,
MSPH, Kaiser Permanente Colorado
``Our AHRQ grant to study the transformation of medical practices
into patient-centered medical homes allowed us to develop a good
partnership with the Minnesota Dept. of Health and Dept. of Human
Services to evaluate a State experiment certifying primary care
practices as medical homes. That partnership facilitated access to
information and practices and helped us learn many lessons about this
transformation and its impacts. These lessons were then provided to
those MN departments and to the practices that were becoming medical
homes, with the purpose of improving quality, cost, and access.'' Leif
I. Solberg, MD, Director for Care Improvement Research, HealthPartners
Institute for Education and Research, Bloomington, MN
Research related to the most common acute, chronic, and comorbid
conditions that primary care clinicians treat is lacking. AHRQ supports
research to improve healthcare quality, reduce costs, advance patient
safety, decrease medical errors, and broaden access to essential
services. This research is essential to create a robust primary care
system for our Nation--one that delivers higher quality of care and
better health while reducing the rising cost of care. Despite this
need, little is known about how patients can best decide how and when
to seek care, how to introduce and disseminate new discoveries into
real life practice, and how to maximize appropriate care. This type of
research requires sufficient funding for AHRQ, so it can help
researchers address the problems confronting our health system today.
We recommend the Committee fund AHRQ at a base, discretionary level
of at least $375 million for fiscal year 2015.
[This statement was submitted by Grant Hoekzema, MD, Chair, Council
of Academic Family Medicine.]
______
Prepared Statement of the Council on Social Work Education
On behalf of the Council on Social Work Education (CSWE), I am
pleased to offer this written testimony to the Senate Appropriations
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies for inclusion in the official Committee record. I will
focus my testimony on the importance of fostering a skilled,
sustainable, and diverse social work workforce to meet the healthcare
needs of the nation through professional education, training, and
financial support programs for social workers at the Department of
Health and Human Services (HHS) and the Department of Education (ED).
CSWE is a nonprofit national association representing more than
2,500 individual members and more than 700 master's and baccalaureate
programs of professional social work education. Founded in 1952, this
partnership of educational and professional institutions, social
welfare agencies, and private citizens houses the sole accrediting body
for social work education in the United States. Social work education
prepares students for leadership and professional interdisciplinary
practice with individuals, families, groups, and communities in a wide
array of service sectors, including health, mental health, adult and
juvenile justice, PK-12 education, child welfare, aging, and others.
Social work practice is facilitated by a longstanding tradition of
collaborative relationships working with health professions colleagues
including direct care workers, families, doctors, nurses, pharmacists
and others yielding a result that empowers individuals to be healthy,
productive, contributing members of their communities. Social workers
recognize that social determinants of health are a critical component
in meeting the health needs of certain populations, and social work
education and practice follow this framework. As Federal agencies look
to reduce cost and improve quality, social workers can help lead in
this area.
Recruitment and retention in social work continues to be a serious
challenge that threatens the workforce's ability to meet societal
needs. The U.S. Bureau of Labor Statistics estimates that employment
for social workers is expected to grow faster than the average for all
occupations through 2022, particularly for social workers specializing
in the aging population and working in rural areas. In addition, the
need for social workers specializing in mental health and substance use
is expected to grow by 23 percent over the 2012-2022 decade.\1\
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\1\ U.S. Bureau of Labor Statistics. 2012. Occupational Outlook
Handbook: Social Workers, http://data.bls.gov/cgi-bin/print.pl/oco/
ocos060.htm. Retrieved March 21, 2014.
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CSWE understands the difficult funding decisions Congress is faced
with. In these challenging times, it is my hope that the Committee will
prioritize funding for health professions training in fiscal year (FY)
2015 to help to ensure that the nation continues to foster a
sustainable, skilled, and culturally competent workforce that will be
able to keep up with the increasing demand for social work services and
meet the unique healthcare needs of diverse communities.
health resources and services administration (hrsa)
title vii and title viii health professions programs
CSWE urges the Committee to provide $520 million in fiscal year
2015 for the health professions education programs authorized under
Titles VII and VIII of the Public Health Service Act and administered
through HRSA, which is equal to the fiscal year 2012 enacted level.
HRSA's Title VII and Title VIII health professions programs represent
Federal programs designed to train healthcare providers in an
interdisciplinary way to meet the healthcare needs of all Americans,
including the underserved and those with special needs. These programs
also serve to increase minority representation in the healthcare
workforce through targeted programs that improve the quality,
diversity, and geographic distribution of the health professions
workforce. The Title VII and Title VIII programs provide loans, loan
guarantees and scholarships to students, and grants to institutions of
higher education and non-profit organizations to help build and
maintain a robust healthcare workforce. Social workers and social work
students are eligible for funding from the suite of Title VII health
professions programs.
The Title VII and Title VIII programs were reauthorized in 2010,
which helped to improve the efficiency of the programs as well as
enhance efforts to recruit and retain health professionals in
underserved communities. Recognizing the severe shortages of mental and
behavioral health providers within the healthcare workforce, a new
Title VII program was authorized in the Patient Protection and
Affordable Care Act (Public Law 111-148). The Mental and Behavioral
Health Education and Training Grants program provides grants to
institutions of higher education (schools of social work and other
mental health professions) for faculty and student recruitment and
professional education and training. The program received first-time
funding of $10 million in the final fiscal year 2012 appropriations
bill. The President's fiscal year 2015 budget request would continue to
support the program at HRSA and also through a partnership with the
Substance Abuse and Mental Health Services Administration (SAMHSA) to
expand the mental health workforce by almost 3,500 professionals
focused on transition-age youth (16-25). CSWE urges the Committee to
maintain funding at HRSA for this critically important program at the
highest level possible in fiscal year 2015 and include schools of
social work as eligible entities. CSWE supports the proposed expansion
of the program but encourages the committee to be inclusive of non-
youth populations needing mental and behavioral health services and not
to reduce the scope of the original intent of the program through the
expansion.
substance abuse and mental health services administration (samhsa)
minority fellowship program
CSWE urges the Committee to appropriate the highest level possible
for the Minority Fellowship Program (MFP) in fiscal year 2015. The goal
of the SAMHSA Minority Fellowship Program (MFP) is to achieve greater
numbers of minority doctoral students preparing for leadership roles in
the mental health and substance use fields.\2\ CSWE is one of six
grantees of this critical program and administers funds to exceptional
minority doctoral social work students. Other grantees include national
organizations representing nursing, psychology, psychiatry, marriage
and family therapy, and professional counselors. SAMHSA makes grants to
these six organizations, who in turn recruit minority doctoral students
into the program from the six distinct professions. CSWE administers
the funds to qualified doctoral students and helps facilitate mentoring
and networking throughout the duration of the fellowship as well as
facilitates an alumni group to help continue to engage former fellows
long after their formal fellowship has ended.
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\2\ According to SAMHSA, minorities make up over one-fourth of the
population, but less than 20 percent of behavioral health providers
come from ethnic minority communities. Retrieved from SAMHSA Minority
Fellowship Program, http://www.samhsa.gov/minorityfellowship/.
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Since its inception in 1974, the MFP has helped support doctoral-
level professional education for over 1,000 ethnic minority social
workers, psychiatrists, psychologists, psychiatric nurses, and family
and marriage therapists. Still, the program continues to struggle to
keep up with the demands facing these health professions. Severe
shortages of mental health professionals often arise in underserved
areas due to the difficulty of recruitment and retention in the public
sector. Nowhere are these shortages more prevalent than within Tribal
communities, where mental illness and substance use go largely
untreated and incidences of suicide continue to increase. Studies have
shown that ethnic minority mental health professionals practice in
underserved areas at a higher rate than non-minorities. Furthermore, a
direct positive relationship exists between the numbers of ethnic
minority mental health professionals and the utilization of needed
services by ethnic minorities.\3\ The President's fiscal year 2015
budget request includes $10 million for MFP activities. CSWE urges the
committee to support this request, including at least $5.4 million for
MFP core activities.
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\3\ U.S. Department of Health and Human Services, Substance Abuse
and Mental Health Services Administration, Center for Mental Health
Services. (2001). Mental Health: Culture, Race, and Ethnicity--A
Supplement to Mental Health: A Report of the Surgeon General. Retrieved
from http://www.surgeongeneral.gov/library/mentalhealth/cre/sma-01-
3613.pdf.
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department of education
student aid programs
CSWE supports full funding to keep the maximum Pell Grant at $5,830
in fiscal year 2015. While Congress is understandably focused on
identifying a solution that will place the Pell Grant program on solid
ground in regards to its fiscal future, we urge you to remember that
these grants help to ensure that all students, regardless of their
economic situation, can achieve higher education. Moreover, as
described above with regard to the SAMHSA Minority Fellowship Program,
one goal of social work education is recruiting students from diverse
backgrounds (which includes racial, economic, religious, and other
forms of diversity) with the hope that they will return to serve
diverse communities once they have completed their education. In many
cases, this includes encouraging social workers to return to their own
communities and apply the skills they have acquired through their
social work education to individuals, groups, or families in need.
Without support such as Pell Grants, many low-income individuals would
not be able to access higher education, and in turn, would not acquire
skills needed to best serve in the communities that would most benefit
from their service.
The Graduate Assistance in Areas of National Need (GAANN) program
provides graduate traineeships in critical fields of study. Currently,
social work is not defined as an area of national need for this
program; however it was recognized by Congress as an area of national
need in the Higher Education Opportunity Act of 2008. We encourage ED
to recognize the importance of including social work in the GAANN
program in future years. Inclusion of social work would help to
significantly enhance graduate education in social work, which is
critically needed in the country's efforts to foster a sustainable
health professions workforce. CSWE urges the Subcommittee to provide
$31 million for the GAANN Program and include social as an area of
national need.
CSWE supports efforts at ED to help students with high debt loads
serve in low paying positions. The Income-Based Repayment (IBR) program
and the Public Service Loan Forgiveness programs in particular help
students graduating from social work programs who wish to serve in
high-needs communities, often at a low salary level. CSWE urges the
Subcommittee to support loan repayment programs without a cap on
repayment support at ED.
Thank you for the opportunity to express these views. Please do not
hesitate to call on the Council on Social Work Education should you
have any questions or require additional information.
[This statement was submitted by Dr. Darla Spence Coffey,
President, Council on Social Work Education.]
______
Prepared Statement of the Crohn's and Colitis Foundation of America
summary of fiscal year 2015 recommendations
_______________________________________________________________________
--$32 Billion for the National Institutes of Health (NIH) at an
increase of $1 billion over fiscal year 2014. Increase funding
for the National Cancer Institute (NCI), the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK) and the
National Institute of Allergy and Infectious Diseases (NIAID)
by 12 percent.
--Continued focus on Digestive Disease Research and Education At NIH,
including Inflammatory Bowel Disease (IBD) and Colorectal
Cancer.
--$6,860,000 For the Centers For Disease Control and Prevention's
(CDC) IBD Epidemiology Activities.
--$50 Million For the Center for Disease Control and Prevention's
(CDC) Colorectal Cancerscreening and Prevention Program.
_______________________________________________________________________
Thank you for the opportunity to submit testimony to the
Subcommittee. CCFA has remained committed to its mission of finding a
cure for Crohn's disease and ulcerative colitis and improving the
quality of life of children and adults affected by these diseases for
over 46 years. Impacting an estimated 1.4 million Americans, 30 percent
of whom are diagnosed in their childhood years, Inflammatory Bowel
Diseases (IBD) are chronic disorders of the gastrointestinal tract
which cause abdominal pain, fever, and intestinal bleeding. IBD
represents a major cause of morbidity from digestive illness and has a
devastating impact on both patients and their families.
The social and economic impact of digestive disease is enormous and
difficult to grasp. Digestive disorders afflict approximately 65
million Americans. This results in 50 million visits to physicians,
over 10 million hospitalizations, collectively 230 million days of
restricted activity. The total cost associated with digestive diseases
has been conservatively estimated at $60 billion a year.
The CCFA would like to thank the subcommittee for its past support
of digestive disease research and prevention programs at the National
Institutes of Health (NIH) and the Centers for Disease Control and
Prevention (CDC).
Specifically the CCFA recommends:
--$32 billion for the NIH.
--$2.16 billion for the National Institute of Diabetes and Digestive
and Kidney Disease (NIDDK).
We at the CCFA respectfully request that any increase for NIH does
not come at the expense of
other Public Health Service agencies. With the competing and the
challenging budgetary constraints the Subcommittee currently operates
under, the CCFA would like to highlight the research being accomplished
by NIDDK which warrants the increase for NIH.
inflammatory bowel disease
In the United States today about one million people suffer from
Crohn's disease and ulcerative colitis, collectively known as IBD.
These are serious diseases that affect the gastrointestinal tract
causing bleeding, diarrhea, abdominal pain, and fever. Complications
arising from IBD can include anemia, ulcers of the skin, eye disease,
colon cancer, liver disease, arthritis, and osteoporosis. The cause of
IBD is still unknown, but research has led to great breakthroughs in
therapy.
In recent years researchers have made significant progress in the
fight against IBD. The CCFA encourages the subcommittee to continue its
support of IBD research at NIDDK and NIAID at a level commensurate with
the overall increase for each institute. The DDNC would like to applaud
the NIDDK for its strong commitment to IBD research through the
Inflammatory Bowel Disease Genetics Research Consortium. The CCFA urges
the Consortium to continue its work in IBD research.
centers for disease control and prevention ibd epidemiology
CDC, in collaboration with a nationwide, geographically diverse
network of large managed healthcare delivery systems, has led an
epidemiological study of IBD to understand IBD incidence, prevalence,
demographics, and healthcare utilization. The group, comprised of
investigators at the Massachusetts General Hospital in Boston, Rhode
Island Hospital, the Crohn's and Colitis Foundation of America, and
CDC, has piloted the Ocean State Crohn's and Colitis Registry (OSCAR),
which includes both pediatric and adult patients. Since 2008, the OSCAR
investigators have recruited 22 private-practice groups and hospital
based physicians in Rhode Island and are that enrolling newly diagnosed
patients into the registry. This study found an average annual
incidence rate of 8.4 per 100,000 people for Crohn's disease and 12.4
per 100,000 for Ulcerative Colitis; published in Inflammatory Bowel
Disease Journal, April 2007.
--Over the course of the initial 3-year epidemiologic collaboration,
CDC laboratory scientists and epidemiologists worked to improve
detection tools and epidemiologic methods to study the role of
infections (infectious disease epidemiology) in pediatric IBD,
collaborating with extramural researchers who were funded by a
National Institutes of Health (NIH) research award.
--Since 2006, CDC epidemiologists have been working in conjunction
with the Crohn's and Colitis Foundation of American and a large
health maintenance organization to better understand the
natural history of IBD and factors that predict the course of
disease.
The Crohn's and Colitis Foundation of America encourages the CDC to
continue to support a nationwide IBD surveillance and epidemiological
program in fiscal year 2014.
colorectal cancer prevention
Colorectal cancer is the third most commonly diagnosed cancer for
both men and woman in the United States and the second leading cause of
cancer-related deaths. Colorectal cancer affects men and women equally.
The CCFA recommends a funding level of $50 million for the CDC's
Colorectal Cancer Screening and Prevention Program. This important
program supports enhanced colorectal screening and public awareness
activities throughout the United States. The DDNC also supports the
continued development of the CDC-supported National Colorectal Cancer
Roundtable, which provides a forum among organizations concerned with
colorectal cancer to develop and implement consistent prevention,
screening, and awareness strategies.
conclusion
The CCFA understands the challenging budgetary constraints and
times we live in that this Subcommittee is operating under, yet we hope
you will carefully consider the tremendous benefits to be gained by
supporting a strong research and education program at NIH and CDC.
Millions of Americans are pinning their hopes for a better life, or
even life itself, on digestive disease research conducted through the
National Institutes of Health. Mr. Chairman, on behalf of our patients,
we appreciate your consideration of our view. We look forward to
working with you and your staff.
______
Prepared Statement of the Cystic Fibrosis Foundation
On behalf of the Cystic Fibrosis Foundation (CFF) and the 30,000
people with cystic fibrosis (CF) in the United States, we submit the
following testimony to the Senate Appropriations Committee's
Subcommittee on Labor, Health and Human Services, Education, and
Related Agencies on our funding requests for fiscal year 2015. The
Foundation requests the highest possible funding level for the National
Institutes of Health (NIH), particularly the National Center for
Advancing Translational Sciences (NCATS) and programs under its
jurisdiction, including the Cures Acceleration Network (CAN) and the
Clinical and Translational Science Awards (CTSA).
Collaboration and Innovation: The Future of Drug Development
NIH uses appropriated funds wisely and effectively by supporting
programs that promote efficiency and innovation in drug discovery and
encouraging collaboration across sectors. Many of these effective,
collaborative ventures aim to translate basic research into promising
potential treatments, speeding the discovery of therapies for those
with serious illnesses like cystic fibrosis. We urge you to ensure that
these critical programs are sufficiently funded and receive the support
they need. For those with rare genetic diseases like CF, treatments and
cures cannot wait.
As an example of the NIH's cooperative, innovative approach, in
February the agency announced the establishment of the Accelerating
Medicines Partnership (AMP), a joint venture between NIH,
pharmaceutical companies, and several non-profit organizations to
characterize biomarkers and distinguish biological targets that are
most likely to respond to new therapies. The AMP will begin with three
to five year pilot projects in Alzheimer's disease, type 2 diabetes,
rheumatoid arthritis and systemic lupus erythematosus.
Through this cross-sector partnership, NIH and industry partners
share expertise, resources, and data in order to speed the development
of treatments. Furthermore, industry partners have agreed to make AMP
data and analyses available to the biomedical community for use in
future study.
Drug development is risky, expensive, and time-consuming, and there
is a 95 percent failure rate for drug candidates. This kind of cross-
sector partnership aims to reduce the time, cost, and risk of drug
development by sharing resources so diseases can be analyzed in ways
that drug companies have not been able to do on their own.
Importantly, industry will fund one-half of the $230 million budget
while NIH will provide the other half. The Federal money used for this
project acts as seed money, a jumping off point for private sector
investment in drug discovery for serious diseases. This type of
cooperative approach saves taxpayer funds in the long run and can save
lives.
While AMP is not administered by the National Center for Advancing
Translational Sciences (NCATS), this NIH center spearheads similarly
innovative programs that encourage collaboration, improve the process
by which diagnostics and therapeutics are developed, and improve the
efficiency of the translation of basic scientific discoveries into new
therapies.
For example, the Cures Acceleration Network (CAN), a program under
the umbrella of NCATS, funds a variety of initiatives designed to
address scientific and technical challenges that hinder transitional
research. For instance, CAN provides funding for the Tissue Chip for
Drug Screening Initiative, a joint project with the Defense Advanced
Research Projects Agency (DARPA) and the Food and Drug Administration
(FDA) to develop 3-D human tissue chips. These chips, composed of
diverse human cells and tissues, mimic how drugs interact with the
human body. If successful, these chips could make drug safety and
efficacy assessments possible at an earlier stage in drug development,
enabling investigators to concentrate on the most promising new drugs.
Unfortunately, CAN has been chronically underfunded. Since its
inception as part of the Patient Protection and Affordable Care Act in
2010, it has been funded at approximately $10 million per year for
fiscal years 2012, 2013, and 2014. We urge the Committee to provide at
least the funding level requested in the President's fiscal year 2015
budget--$29.8 million. CAN needs additional funding for projects that
will help move new treatments to patients.
Similarly, the Clinical and Translational Science Awards (CTSA)
program in the NCATS Division of Clinical Innovation demonstrates
NCATS' innovative, collaborative approach. This program supports a
national consortium of more than 60 medical research institutions that
work together on research. Its goals are to accelerate the process of
translating laboratory discoveries into treatments for patients, train
a new generation of researchers, and engage communities in clinical
research efforts.
Institutional CTSA awards provide academic homes for translational
sciences and support research resources needed by local and national
research communities to improve the quality and efficiency of all
phases of translational research. They also support the training of
clinical and translational scientists and the development of all
disciplines needed for a robust translational research workforce.
CTSA funds have the potential to be used in new ways. For example,
CTSA's academic homes can serve as a platform for sharing patient
registry data. As the CF Foundation has seen with its Therapeutics
Development Network of clinical trial sites, the sharing of patient
registry information, including demographics and health outcomes, among
sites is integral to conducting CF research. This strategy could be
beneficial in the wider disease community.
A Culture of Collaboration: The Cystic Fibrosis Model
The Cystic Fibrosis Foundation has long been engaged in
partnerships with industry and supports a collaborative network of care
centers and clinical trial sites. As such, CFF knows firsthand that
this type of cooperation can lead to the targeted treatments that
change the face of many life-threatening diseases.
Because drug research and development is a lengthy, expensive and
risky process, CFF pioneered a successful ``venture philanthropy''
business model to drive drug development for this rare disease. By
collaborating with pharmaceutical companies and providing financial,
scientific, and clinical support in order to ``de-risk'' the
development process, CFF speeds development of much-needed treatments.
Through its venture philanthropy model, the Foundation is able to
invest in promising CF research and a robust pipeline of potential
therapies that target the disease from every angle. Nearly every CF
drug available today was made possible because of the Foundation's
support and ongoing work with researchers and the pharmaceutical
industry to find a cure.
In January 2012, the Food and Drug Administration approved
Kalydeco, a groundbreaking cystic fibrosis drug developed by Vertex
Pharmaceuticals in partnership with the CF Foundation. This targeted
drug is the first to address the underlying genetic cause of cystic
fibrosis in a subset of the CF population.
Kalydeco was approved in only 3 months, one of the fastest
approvals in the FDA's history. According to Margaret A. Hamburg, M.D.,
Commissioner of the FDA, ``The unique and mutually beneficial
partnership that led to the approval of Kalydeco serves as a great
model for what companies and patient groups can achieve if they
collaborate on drug development.''
Throughout Kalydeco's review, the Cystic Fibrosis Foundation and
renowned CF experts worked closely with Vertex Pharmaceuticals and the
FDA, providing valuable insight on specific issues related to CF,
clinical research on CF treatments, and other issues related to the
product and its review. We believe that this collaborative process
contributed to a more efficient evaluation, and is a testament to what
can be achieved when stakeholders collaborate across sectors on
critical drugs for patients.
Akin to AMP, the Cystic Fibrosis Foundation also recognizes the
profound importance of data sharing, which is a critical way to enable
efficient drug development. The Cystic Fibrosis Foundation Therapeutics
Development Network (TDN) of clinical trial centers has accumulated
data from over 40 cystic fibrosis studies in the last 15 years. This
data resides in a repository specifically meant to facilitate sharing
among our research community.
* * *
As the Committee determines its funding levels for fiscal year
2015, we request your attention to the critical nature of NIH's work
and the innovation it supports, and urge robust funding for this
important agency. The CF Foundation stands ready to work with the
Committee, NIH, and Congressional leaders on the challenges ahead.
Thank you for your consideration.
______
Prepared Statement of the Digestive Disease National Coalition
summary of fiscal year 2015 recommendations
_______________________________________________________________________
--$32 Billion for the National Institutes of Health (NIH) at an
increase of $1 billion over fiscal year 2014. Increase funding
for the National Cancer Institute (NCI), the National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK) and the
National Institute of Allergy and Infectious Diseases (NIAID)
by 12 percent.
--Continue focus on Digestive Disease Research and Education at NIH,
Including Inflammatory Bowel Disease (IBD), Hepatitis and other
Liver Diseases, Irritable Bowel Syndrome (IBS), Colorectal
Cancer, Endoscopic Research, Pancreatic Cancer, and Celiac
Disease.
--$50 Million for the Centers For Disease Control and Prevention's
(CDC) Hepatitis Prevention and Control Activities.
--$50 Million for the Center for Disease Control and Prevention's
(CDC) Colorectal Cancerscreening and Prevention Program.
_______________________________________________________________________
Chairman Harkin, thank you for the opportunity to again submit
testimony to the Subcommittee. Founded in 1978, the Digestive Disease
National Coalition (DDNC) is a voluntary health organization comprised
of 35 professional societies and patient organizations concerned with
the many diseases of the digestive tract. The DDNC promotes a strong
Federal investment in digestive disease research, patient care, disease
prevention, and public awareness. The DDNC is a broad coalition of
groups representing disorders such as Inflammatory Bowel Disease (IBD),
Hepatitis and other liver diseases, Irritable Bowel Syndrome (IBS),
Pancreatic Cancer, Ulcers, Pediatric and Adult Gastroesophageal Reflux
Disease, Colorectal Cancer, and Celiac Disease.
The social and economic impact of digestive disease is enormous and
difficult to grasp. Digestive disorders afflict approximately 65
million Americans. This results in 50 million visits to physicians,
over 10 million hospitalizations, collectively 230 million days of
restricted activity. The total cost associated with digestive diseases
has been conservatively estimated at $60 billion a year.
The DDNC would like to thank the Subcommittee for its past support
of digestive disease research and prevention programs at the National
Institutes of Health (NIH) and the Centers for Disease Control and
Prevention (CDC).
Specifically the DDNC recommends:
--32 billion for the NIH.
--$2.16 billion for the National Institute of Diabetes and Digestive
and Kidney Disease (NIDDK).
We at the DDNC respectfully request that any increase for NIH does
not come at the expense of
other Public Health Service agencies. With the competing and the
challenging budgetary constraints the Subcommittee currently operates
under, the DDNC would like to highlight the research being accomplished
by NIDDK which warrants the increase for NIH.
inflammatory bowel disease
In the United States today about one million people suffer from
Crohn's disease and ulcerative colitis, collectively known as
Inflammatory Bowel Disease (IBD). These are serious diseases that
affect the gastrointestinal tract causing bleeding, diarrhea, abdominal
pain, and fever. Complications arising from IBD can include anemia,
ulcers of the skin, eye disease, colon cancer, liver disease,
arthritis, and osteoporosis. The cause of IBD is still unknown, but
research has led to great breakthroughs in therapy.
In recent years researchers have made significant progress in the
fight against IBD. The DDNC encourages the subcommittee to continue its
support of IBD research at NIDDK and NIAID at a level commensurate with
the overall increase for each institute. The DDNC would like to applaud
the NIDDK for its strong commitment to IBD research through the
Inflammatory Bowel Disease Genetics Research Consortium. The DDNC urges
the Consortium to continue its work in IBD research. Therefore the DDNC
and its member organization the Crohn's and Colitis Foundation of
America encourage the CDC to continue to support a nationwide IBD
surveillance and epidemiological program in fiscal year 2015.
viral hepatitis: a looming threat to health
The DDNC applauds all the work NIH and CDC have accomplished over
the past year in the areas of hepatitis and liver disease. The DDNC
urges that funding be focused on expanding the capability of State
health departments, particularly to enhance resources available to the
hepatitis State coordinators. The DDNC also urges that CDC increase the
number of cooperative agreements with coalition partners to develop and
distribute health education, communication, and training materials
about prevention, diagnosis and medical management for viral hepatitis.
The DDNC supports $50 million for the CDC's Hepatitis Prevention
and Control activities. The hepatitis division at CDC supports the
hepatitis C prevention strategy and other cooperative nationwide
activities aimed at prevention and awareness of hepatitis A, B, and C.
The DDNC also urges the CDC's leadership and support for the National
Viral Hepatitis Roundtable to establish a comprehensive approach among
all stakeholders for viral hepatitis prevention, education, strategic
coordination, and advocacy.
colorectal cancer prevention
Colorectal cancer is the third most commonly diagnosed cancer for
both men and woman in the United States and the second leading cause of
cancer-related deaths. Colorectal cancer affects men and women equally.
The DDNC recommends a funding level of $50 million for the CDC's
Colorectal Cancer Screening and Prevention Program. This important
program supports enhanced colorectal screening and public awareness
activities throughout the United States. The DDNC also supports the
continued development of the CDC-supported National Colorectal Cancer
Roundtable, which provides a forum among organizations concerned with
colorectal cancer to develop and implement consistent prevention,
screening, and awareness strategies.
pancreatic cancer
In 2013, an estimated 33,730 people in the United States will be
found to have pancreatic cancer and approximately 32,300 died from the
disease. Pancreatic cancer is the fifth leading cause of cancer death
in men and women. Only l out of 4 patients will live 1 year after the
cancer is found and only l out of 25 will survive five or more years.
The National Cancer Institute (NCI) has established a Pancreatic
Cancer Progress Review Group charged with developing a detailed
research agenda for the disease. The DDNC encourages the Subcommittee
to provide an increase for pancreatic cancer research at a level
commensurate with the overall percentage increase for NCI and NIDDK.
irritable bowel syndrome (ibs)
IBS is a disorder that affects an estimated 35 million Americans.
The medical community has been slow in recognizing IBS as a legitimate
disease and the burden of illness associated with it. Patients often
see several doctors before they are given an accurate diagnosis. Once a
diagnosis of IBS is made, medical treatment is limited because the
medical community still does not understand the pathophysiology of the
underlying conditions.
Living with IBS is a challenge, patients face a life of learning to
manage a chronic illness that is accompanied by pain and unrelenting
gastrointestinal symptoms. Trying to learn how to manage the symptoms
is not easy. There is a loss of spontaneity when symptoms may intrude
at any time. IBS is an unpredictable disease. A patient can wake up in
the morning feeling fine and within a short time encounter abdominal
cramping to the point of being doubled over in pain and unable to
function.
The DDNC recommends that NIDDK increase its research portfolio on
Functional Gastrointestinal Disorders and Motility Disorders.
conclusion
The DDNC understands the challenging budgetary constraints and
times we live in that this Subcommittee is operating under, yet we hope
you will carefully consider the tremendous benefits to be gained by
supporting a strong research and education program at NIH and CDC.
Millions of Americans are pinning their hopes for a better life, or
even life itself, on digestive disease research conducted through the
National Institutes of Health. Mr. Chairman, on behalf of the millions
of digestive disease sufferers, we appreciate your consideration of the
views of the Digestive Disease National Coalition. We look forward to
working with you and your staff.
______
Prepared Statement of Dystonia Medical Research Foundation
summary of recommendations for fiscal year 2015
_______________________________________________________________________
--$32 billion for the National Institutes of Health (NIH) and
proportional increases across its institutes and centers.
--Continue to support the Dystonia Coalition Within the Rare Disease
Clinical Research Network (RDCRN) coordinated by the Office of
Rare Diseases Research (ORDR) in the National Center for
Advancing Translational Sciences (NCATS).
--Expand Dystonia Research supported by NIH through the National
Institute on Neurological Disorders and Stroke (NINDS), the
National Institute on Deafness and Other Communication
Disorders (NIDCD) and the National Eye Institute (NEI).
_______________________________________________________________________
Dystonia is a neurological movement disorder characterized by
involuntary muscle spasms that cause the body to twist, repetitively
jerk, and sustain postural deformities. Focal dystonia affects specific
parts of the body, while generalized dystonia affects multiple parts of
the body at the same time. Some forms of dystonia are genetic but
dystonia can also be caused by injury or illness. Although dystonia is
a chronic and progressive disease, it does not impact cognition,
intelligence, or shorten a person's life span. Conservative estimates
indicate that between 300,000 and 500,000 individuals suffer from some
form of dystonia in North America alone. Dystonia does not
discriminate, affecting all demographic groups. There is no known cure
for dystonia and treatment options remain limited.
Although little is known regarding the causes and onset of
dystonia, two therapies have been developed that have demonstrated a
great benefit to patients and have been particularly useful for
controlling patient symptoms. Botulinum toxin (e.g., Botox, Xeomin,
Disport and Myobloc) injections and deep brain stimulation have shown
varying degrees of success alleviating dystonia symptoms. Until a cure
is discovered, the development of management therapies such as these
remains vital, and more research is needed to fully understand the
onset and progression of the disease in order to better treat patients.
dystonia research at the national institutes of health (nih)
Currently, dystonia research at NIH is supported by the National
Institute of Neurological Disorders and Stroke (NINDS), the National
Institute on Deafness and Other Communication Disorders (NIDCD), the
National Eye Institute (NEI), and the Office of Rare Diseases Research
(ORDR) within the National Center for Advancing Translational Sciences
(NCATS).
ORDR coordinates the Rare Disease Clinical Research Network (RDCRN)
which provides support for studies on the natural history,
epidemiology, diagnosis, and treatment of rare diseases. RDCRN includes
the Dystonia Coalition, a partnership between researchers, patients,
and patient advocacy groups to advance the pace of clinical research on
cervical dystonia, blepharospasm, spasmodic dysphonia, craniofacial
dystonia, and limb dystonia. The Dystonia Coalition has made tremendous
progress in preparing the patient community for clinical trials as well
as funding promising studies that hold great hope for advancing our
understanding and capacity to treat primary focal dystonias. DAN urges
the subcommittee to continue its support for the Dystonia Coalition,
part of the Rare Disease Clinical Research Network coordinated by ORDR
within NCATS.
The majority of dystonia research at NIH is supported by NINDS.
NINDS has utilized a number of funding mechanisms in recent years to
study the causes and mechanisms of dystonia. These grants cover a wide
range of research including the genetics and genomics of dystonia, the
development of animal models of primary and secondary dystonia,
molecular and cellular studies in inherited forms of dystonia,
epidemiology studies, and brain imaging. DAN urges the subcommittee to
support NINDS in conducting and expanding critical research on
dystonia.
NIDCD and NEI also support research on dystonia. NIDCD has funded
many studies on brainstem systems and their role in spasmodic
dysphonia, or laryngeal dystonia. Spasmodic dysphonia is a form of
focal dystonia which involves involuntary spasms of the vocal cords
causing interruptions of speech and affecting voice quality. NEI
focuses some of its resources on the study of blepharospasm.
Blepharospasm is an abnormal, involuntary blinking of the eyelids which
can render a patient legally blind due to a patient's inability to open
their eyelids. DAN encourages partnerships between NINDS, NIDCD and NEI
to further dystonia research.
In summary, DAN recommends the following for fiscal year 2015:
--$32 billion for NIH and a proportional increase for its Institutes
and Centers
--Support for the Dystonia Coalition within the Rare Diseases
Clinical Research Network coordinated by ORDR within NCATS
--Expansion of the dystonia research portfolio at NIH through NINDS,
NIDCD, NEI, and ORDR
the dystonia advocacy network
The Dystonia Medical Research Foundation submits these comments on
behalf of the Dystonia Advocacy Network (DAN), a collaborative network
of five patient organizations: the Benign Essential Blepharospasm
Research Foundation, the Dystonia Medical Research Foundation, the
National Spasmodic Dysphonia Association, the National Spasmodic
Torticollis Association, and ST/Dystonia, Inc. DAN advocates for all
persons affected by dystonia and supports a legislative agenda that
meets the needs of the dystonia community.
DMRF was founded in 1976. Since its inception, the goals of DMRF
have remained to advance research for more effective treatments of
dystonia and ultimately find a cure; to promote awareness and
education; and support the needs and well being of affected individuals
and their families.
Thank you for the opportunity to present the views of the dystonia
community, we look forward to providing any additional information.
[This statement was submitted by Janet Hieshetter, Executive
Director, Dystonia Medical Research Foundation.]
______
Prepared Statement of the Elder Justice Coalition
Chairman Harkin, Ranking Member Moran: On behalf of the Elder
Justice Coalition, a bipartisan 3000 member organization, we thank you
for the opportunity to testify in support of the Department of Health
and Human Services' proposed Elder Justice Initiative in the amount of
$25 million.
Our topic has been and must always be a bipartisan issue:
preventing elder abuse, neglect and exploitation. We ask this
Subcommittee to provide the necessary funding in a bipartisan fashion
as part of the solution to the real national disgrace of elder abuse.
There are more than six million victims of elder abuse; roughly one
of every ten persons over 60. Victims of elder financial abuse lose an
estimated $2.9 billion a year which can include entire life savings.
Other data points to a 16 percent increase in reported cases. However,
a New York State study said for every elder abuse case known to
agencies, twenty-four were unknown.
The $25 million requested in the President's fiscal year 2015
budget for an Elder Justice Initiative which if approved by Congress
would be the first direct appropriation for the bipartisan Elder
Justice Act sponsored in the Senate by Senators Breaux, Hatch and
Baucus.
The funding request includes:
--$13.8 million for Adult Protective Services, including an APS
National Data System and Technical Assistance and national
demonstration grants to both enhance APS data systems and
development of program standards as well as an full evaluation
of APS practices.
--$11.2 million for research including elder abuse screening and to
establish a better knowledge base about elder abuse, neglect
and exploitation.
Data collection is important. The lack of good data has hurt the
elder abuse field and our ability to target efforts to prevent abuse.
Data often drives dollars. For elder abuse to compete effectively for
resources, we must have a good system to collect and analyze data. This
appropriation will also help assess the most likely perpetrators and
victims and direct resources to those most vulnerable.
We support the development of APS program standards. Interventions
for victims of elder abuse are far more complicated than for younger
victims of abuse and family violence. To be effective, APS programs
must have consistency and quality on a national basis. Elder abuse is
happening in all States and districts and in some cases an older person
can be victimized in more than one State.
This initial investment of $25 million means existing Federal
resources could be used more efficiently while also responding to elder
abuse with a systematic approach. This and slowing future victimization
is a solid return on investment.
Why else is this an investment? According to the National Center on
Elder Abuse, the direct medical costs associated with elder abuse now
exceed $5 billion. Victims often end up having to turn to other Federal
programs, especially Medicare and Medicaid, and for financial abuse
victims they may require other assistance including income support.
Some of this can clearly be avoided and savings achieved for these
programs if we make this investment today.
Elder abuse victims are household names like Mickey Rooney or the
late Brooke Astor. We testify for them today but also for those who are
not household names. The voices we don't hear are the ones who need a
voice that you can listen to today.
We say that elder justice is a bipartisan issue. Leaders have
included Senator Hatch, Representative King, as well as former Senator
Lincoln and Representative Emanuel to name a few. Again on a bipartisan
basis this Congress reauthorized the Violence Against Women Act. The
reality is that elder abuse is also a women's issue. The average victim
is an older woman living alone between 75 and 80 at a time when the
Census reports that almost 50 percent of all women over 75 now live
alone--another reason to act now to get resources into elder abuse
prevention.
If one in ten seniors in your State were victims of crime, you
would likely respond by seeking more support for law enforcement as
first responders in the fight against crime. Elder abuse hits one out
of every ten seniors. Let us give needed support to Adult Protective
Services who are the first responders for elder abuse.
Our Coalition also supports funding the Social Services Block Grant
the only funding source for Adult Protective Services today at the
level proposed in the President's budget.
Just as 40 years ago when witnesses came to this Subcommittee
seeking initial funding for the Child Abuse Prevention and Treatment
Act of 1974 we come today asking for this initial $25 million for elder
justice. What is common? A victim of child abuse, like a victim of
elder abuse, is never the same. The role of government should always be
to help the vulnerable of all ages.
Elder justice warrants considerably more than the requested $25
million. The Elder Justice Act also includes increased support for long
term care ombudsmen assisting nursing home residents and funding
forensic centers important to the prosecution of abusers. Since these
are not included, please view the $25 million as a floor to build on,
not a ceiling. We look forward to working with you on ensuring that
this first time appropriations for elder justice provides us with the
best possible value and positive outcomes.
______
Prepared Statement of the Eldercare Workforce Alliance
Mr. Chairman, Ranking Member Moran, and Members of the
Subcommittee: We are writing on behalf of the Eldercare Workforce
Alliance (EWA), which is comprised of 30 national organizations united
to address the immediate and future workforce crisis in caring for an
aging America. As the Subcommittee begins consideration of funding for
programs in fiscal year 2015, the Alliance\**\ urges you to provide
adequate funding for programs designed to increase the number of
healthcare professionals prepared to care for America's growing senior
population and to support family caregivers in the essential role they
play in this regard.
---------------------------------------------------------------------------
\**\ The positions of the Eldercare Workforce Alliance reflect a
consensus of 75 percent or more of its members. This testimony reflects
the consensus of the Alliance and does not necessarily represent the
position of individual Alliance member organizations.
The Eldercare Workforce Alliance is a project of The Advocacy Fund.
---------------------------------------------------------------------------
Today's healthcare workforce is inadequate to meet the special
needs of older Americans, many of whom have multiple chronic physical
and mental health conditions and cognitive impairments. It is estimated
that an additional 3.5 million trained healthcare workers will be
needed by 2030 just to maintain the current level of access and
quality. Without a national commitment to expand training and
educational opportunities, the workforce will be even more constrained
in its ability to care for the growth in the elderly population as the
baby boom generation ages. Reflecting this urgency, the Health
Resources and Services Administration (HRSA) has identified ``enhancing
geriatric/elder care training and expertise'' as one of its top five
priorities.
Of equal importance is supporting the legions of family caregivers
who annually provide billions of hours of uncompensated care that
allows older adults to remain in their homes and communities. The
estimated economic value of family caregivers' unpaid care was
approximately $450 billion in 2009.
The number of Americans over age 65 is expected to reach 70 million
by 2030, representing a 71 percent increase from today's 41 million
older adults. That is why Title VII and Title VIII geriatrics programs
and Administration for Community Living (ACL) programs that support
family caregivers are so critical to ensure that there is a skilled
eldercare workforce and knowledgeable, well-supported family caregivers
available to meet the complex and unique needs of older adults.
We hope you will support a total of $44.7 million in funding for
geriatrics programs in Title VII and Title VIII of the Public Health
Service Act, $172.9 million in funding for programs administered by the
Administration on Aging that support the vital role of family
caregivers in providing care for older adults, and $3 million to
convene a White House Conference on Aging. Specifically, we recommend
the following levels:
--$39.7 million for Title VII Geriatrics Health Professions Programs;
--$5 million for Title VIII Comprehensive Geriatric Education
Programs;
--$172.9 million for Family Caregiver Support Programs; and
--$3 million for a White House Conference on Aging.
Geriatrics health profession training programs are integral to
ensuring that America's healthcare workforce is prepared to care for
the Nation's rapidly expanding population of older adults.
In light of current fiscal constraints, EWA specifically requests
$44.7 million in funding for the following programs administered
through the Health Resources and Services Administration (HRSA) under
Title VII and VIII of the Public Health Service Act. In the 2012-2013
Academic Year, these geriatrics and gerontology programs provided
training to more than 200,000 individuals.
Title VII Geriatrics Health Professions: Appropriations Request: $39.7
Million
Title VII Geriatrics Health Professions programs are the only
Federal programs that seek to increase the number of faculty with
geriatrics expertise in a variety of disciplines. These programs offer
critically important training for the healthcare workforce overall to
improve the quality of care for America's elders.
--Geriatric Academic Career Awards (GACA).--The goal of this program
is to promote the development of academic clinician educators
in geriatrics. Program Accomplishments: In the In the Academic
Year 2012-2013, the GACA program funded 62 full-time junior
faculty. These awardees delivered over 1,100 interprofessional
continuing education courses specific to geriatric-related
topics to over 53,000 students and providers. Additionally,
they presented on research and other topics at 215 local, State
and national conference and published 108 peer-reviewed
publications. HRSA, through the Affordable Care Act (ACA),
expanded the awards to be available to more disciplines. EWA
strongly supports this expansion and requests adequate funding
to reflect this change. Currently, new awardees are selected
only every 5 years. To meet the need for clinician educators in
all disciplines, EWA believes that awards should be made
available to clinical educators annually in order to develop an
adequate number of faculty that can provide geriatric
instruction and training. EWA's fiscal year 2015 request of
$5.5 million will support GAC Awardees in their development as
clinician educators.
--Geriatric Education Centers (GEC).--The goal of Geriatric Education
Centers is to provide high quality interprofessional geriatric
education and training to current members of the health
professions workforce, including geriatrics specialists and
non-specialists. Program Accomplishments: In Academic Year
2012-2013, the 45 GEC grantees developed and provided over
1,650 different continuing education and clinical training
offerings to more than 135,000 health professionals, students,
faculty, and practitioners, significantly exceeding the
program's performance target. Three quarters of the continuing
education offerings were interprofessional in focus. Of the
sites that offered clinical training sessions, 2 out of every 5
of these sites were in a medically underserved community and/or
Health Professional Shortage Area. The GECs provide much needed
education and training. Our funding request of $20 million
includes support for the core work of these 45 GECs.
--Alzheimer's Disease Prevention, Education, and Outreach Program
(GECs).--These funds, included in the President's fiscal year
2015 budget request, allow HRSA to expand efforts to provide
interprofessional continuing education to healthcare
practitioners on Alzheimer's disease and related dementias,
utilizing the already existing Geriatric Education Centers
(GECs). EWA Requests $5.3 million.
--Geriatric Training Program for Physicians, Dentists, (GTPD) and
Behavioral and Mental Health Professions.--The goal of the GTPD
program is to increase the number and quality of clinical
faculty with geriatrics and cultural competence, including
retraining mid-career faculty in geriatrics. Program
Accomplishments: In Academic Year 2012-2013, a total of 64
physicians-including psychiatrists-, dentists, and
psychologists, were supported through this fellowship program.
Fellows delivered over 275 courses to 5,600 trainees. This
program supports training additional faculty in medicine,
dentistry, and behavioral and mental health so that they have
the expertise, skills, and knowledge to teach geriatrics and
gerontology to the next generation of health professionals in
their disciplines. EWA's funding request of $8.9 million will
support this important faculty development program.
Title VIII Geriatrics Nursing Workforce Development Programs:
Appropriations Request: $5 million
Title VIII programs, administered by the HRSA, are the primary
source of Federal funding for advanced education nursing, workforce
diversity, nursing faculty loan programs, nurse education, practice and
retention, comprehensive geriatric education, loan repayment, and
scholarship.
--Comprehensive Geriatric Education Program.--The goal of this
program is to provide quality geriatric education and training
to individuals caring for the elderly. Program Accomplishments:
In Academic Year 2012-2013, a total of 18 00Comprehensive
Geriatric Education Program (CGEP) grantees provided a variety
of services, including over 150 different continuing education
courses to over 11,600 trainees. This program supports
additional training for nurses who care for the elderly;
development and dissemination of curricula relating to
geriatric care; training of faculty in geriatrics; and
continuing education for nurses practicing in geriatrics.
--Traineeships for Advanced Practice Nurses.--Through the ACA, the
Comprehensive Geriatric Education Program was expanded to
include advanced practice nurses who are pursuing long-term
care, geropsychiatric nursing, or other nursing areas that
specialize in care of older adults. In Academic Year 2012-2013,
a total of 74 grantees were awarded traineeships. One in every
4 grantee is considered an underrepresented minority in their
prospective profession. EWA's funding request of $5 million
will support the education and training of individuals who
provide geriatric care.
Administration for Community Living Family Caregiver Support and White
House Conference on Aging: Appropriations Request: $175.9
million
These programs support caregivers, elders, and people with
disabilities by providing critical respite care and other support
services for family caregivers, training and recruitment of care
workers and volunteers, information and outreach, counseling, and other
supplemental services.
--Family Caregiver Support Services.--This program provides a range
of support services to approximately 700,000 family and
informal caregivers annually in States, including counseling,
respite care, training, and assistance with locating services
that help family caregivers in caring for their loved ones at
home for as long as possible. EWA requests $154.5 million.
--Native American Caregiver Support.--This program provides a range
of services to Native American caregivers, including
information and outreach, access assistance, individual
counseling, support groups and training, respite care and other
supplemental services. EWA requests $6.4 million.
--Alzheimer's Disease Support Services:.--One critical focus of this
program is to support the family caregivers who provide
countless hours of unpaid care, thereby enabling their family
members with dementia to continue living in the community.
Funds go towards evidence-based interventions and expand the
dementia-capable home and community-based services, enabling
older adults to remain in the community for as long as
possible. EWA requests $9.5 million.
--Lifespan Respite Care.--This program funds grants to improve the
quality of and access to respite care for family caregivers of
children or adults of any age with special needs. EWA requests
$2.5 million.
--White House Conference on Aging.--As recommended by the bi-partisan
Commission on Long-Term Care, the President's fiscal year 2015
budget request includes $3 million for the convening of a
decennial White House Conference on Aging to bring together
stakeholders and consumers from across the country to discuss
the range of aging issues they face. EWA requests $3 million.
On behalf of the members of the Eldercare Workforce Alliance, we
commend you on your past support for geriatrics workforce programs and
ask that you join us in supporting the eldercare workforce at this
critical time--for all older Americans deserve quality care, now and in
the future. Thank you for your consideration.
[This statement was submitted by Nancy Lundebjerg, MPA, and Michele
Saunders, DMD, MS, MPH, Alliance Co-Convener.]
______
Prepared Statement of the Emergency Nurses Association
The Emergency Nurses Association (ENA), with more than 40,000
members worldwide, is the only professional nursing association
dedicated to defining the future of emergency nursing and emergency
care through advocacy, expertise, innovation, and leadership. Founded
in 1970, ENA develops and disseminates education and practice standards
and guidelines, and affords consultation to both private and public
entities regarding emergency nurses and their practice. ENA has a great
interest in the work of the Senate Labor, Health and Human Services,
Education Subcommittee and especially its efforts to improve the
quality of emergency care for patients in the United States.
For fiscal year 2015, ENA respectfully requests $28 million for
Trauma and Emergency Care Programs (HHS; ASPR/HRSA), $251 million for
Nursing Workforce Development programs (HHS; HRSA), $21.116 million for
the Emergency Medical Services for Children program (HHS; HRSA), $30.1
million to fund poison control centers (HHS; HRSA), $150 million for
the National Institute of Nursing Research (HHS; NIH), and $8.927
million for Rural Health--Access to Emergency Devices (HHS; HRSA).
trauma and emergency care programs
Trauma is the leading cause of death for persons younger than 44
and the fourth-leading cause of death for all ages. In States with an
established trauma system, patients are 20 percent more likely to
survive a traumatic injury. Victims of traumatic injury treated at a
Level I trauma center are 25 percent more likely to survive than those
treated at a general hospital.
Our trauma and emergency medical systems are designed to transport
seriously injured individuals to trauma centers quickly. However, due
to a lack of financial resources, 45 million Americans do not have
access to a major trauma center within the ``golden hour'' following an
injury when chances of survival are highest.
Trauma and emergency care programs, which are authorized under the
Public Health Service Act, provide much-needed money to the States to
develop and enhance of trauma systems. These programs are critical to
the efficient delivery of services through trauma centers, as well as
to the development of regionalized systems of trauma and emergency care
that ensure timely access for injured patients to appropriate
facilities. This modest investment can yield substantial returns in
terms of cost efficiencies and, most importantly, saved lives.
Therefore, ENA respectfully requests $28 million in fiscal year
2015 for trauma and emergency care programs.
nursing workforce development programs
The nursing profession faces significant challenges to ensure that
there will be an adequate number of qualified nurses to meet the
growing healthcare needs of Americans. It is estimated that 80 million
Baby Boomers turned 65 last year. This growing elderly population will
seek healthcare services in a multitude of settings and the care they
depend upon will require a highly educated and skilled nursing
workforce. A 2014 projection from the U.S. Bureau of Labor Statistics'
2013-2014 Employment Outlook Handbook anticipates that the number of
practicing RNs will grow 19 percent by 2022.
The aging of the Baby Boom generation will deplete the nursing
ranks as well. During the next 10 to 15 years, approximately one-third
of the current nurse workforce will reach retirement age. The
retirement of these experienced nurses has the potential to create a
serious deficit in the nursing pipeline. At the same time, our colleges
cannot keep up with the demand for new nurses. According to the
American Association of Colleges of Nursing's (AACN) 2013-2014
Enrollment and Graduations in Baccalaureate and Graduate Programs in
Nursing survey, 78,089 qualified applications were turned away from
nursing schools in 2013 alone.
Title VIII Nursing Workforce Development programs address these
factors and help support the training of qualified nurses. They not
only enhance nursing education at all levels, from entry-level to
graduate study, but they also support nursing schools that educate
nurses for practice in rural and medically underserved communities.
Another important part of Title VIII is the Faculty Loan Program which
is critical to alleviating the large shortage in nursing faculty.
Overall, more than 80,000 nurses and nursing students were trained and
educated last year with the help of Title VIII nursing workforce
development programs.
Therefore, ENA respectfully requests $251 million in fiscal year
2015 for the Nursing Workforce Development programs authorized under
Title VIII of the Public Health Service Act.
emergency medical services for children
The Emergency Medical Services for Children (EMSC) program is the
only Federal program that focuses specifically on improving the
pediatric components of the emergency medical services (EMS) system.
EMSC aims to ensure state-of-the-art emergency medical care for ill and
injured children or adolescents; that pediatric services are well
integrated into an EMS system backed by optimal resources; and that the
entire spectrum of emergency services is provided to children and
adolescents no matter where they live, attend school, or travel.
The Federal investment in the EMSC program produces a wide array of
benefits to children's health through EMSC State Partnership Grants,
EMSC Targeted Issue Grants, the Pediatric Emergency Care Applied
Research Network, and the National EMSC Data Analysis Resource Center.
Therefore, ENA respectfully requests $21.116 million in fiscal year
2015 for the EMSC program.
poison control centers
Poisoning is the second most common form of unintentional death in
the United States. In 2009, 31,768 deaths nationwide were attributed to
unintentional poisoning. Children are especially vulnerable to injury
by poisoning and each day 300 children are treated for poisoning in
emergency departments across the country and two die.
The Nation's 56 poison control centers handle 3.4 million calls
each year, including approximately 680,000 calls from nurses and
doctors who rely on poison centers for an immediate assessment and
expert advice on poisoning cases.
Not only are America's network of poison centers invaluable for
treating victims of poisonings, but the work of the centers also
results in substantial savings to our healthcare system. About 90
percent of people who call with poison emergencies are treated at home
and do not have to visit an emergency department. In more severe
poisoning cases, the expertise provided by poison control centers can
decrease the length of hospital stays. It has been estimated that every
dollar spent on America's poison control centers saves $13.39 in
healthcare costs and lost productivity. The positive impact to the
Federal budget is also significant. A 2012 study by the Lewin Group
found that poison control centers resulted in $313.5 million in savings
to Medicare and $390.2 million in savings to Medicaid.
Therefore, ENA respectfully requests $30.1 million in fiscal year
2015 for poison control centers
the national institute of nursing research (ninr)
As one of the 27 Institutes and Centers at the NIH, NINR funds
research that lays the groundwork for evidence-based nursing practice.
NINR's mission is to promote and improve the health of individuals,
families, communities, and populations. The Institute supports and
conducts clinical and basic research on health and illness to build the
scientific foundation for clinical practice, prevent disease and
disability, manage and eliminate symptoms caused by illness, and
improve palliative and end-of-life care.
NINR nurse-scientists examine ways to improve care models to
deliver safe, high-quality, and cost-effective health services to the
Nation. Our country must look toward prevention as a way of reducing
healthcare expenditures and improving outcomes. The work of NINR is an
important part of this effort.
Moreover, NINR helps to provide needed faculty to support the
education of future generations of nurses. Training programs at NINR
develop future nurse-researchers, many of whom also serve as faculty in
our Nation's nursing schools.
Therefore, ENA respectfully requests $150 million in fiscal year
2015 for the NINR.
rural and community access to emergency devices program
Fewer than 10 percent of people who suffer a cardiac arrest outside
of a hospital setting survive. According to a 2011 study published in
the New England Journal of Medicine, immediate CPR and prompt
defibrillation using an automated external defibrillator (AED) can more
than double a patient's chance of survival.
The Health Resources and Services Administration (HRSA)'s Rural and
Community Access to Emergency Devices Program saves lives of patients
with cardiac arrest. Between August 1, 2008, and July 31, 2010, nearly
800 cardiac arrest victims were reportedly saved through this program.
Funding for this initiative is used to buy AEDs, locate them in public
places where cardiac arrests are more likely to happen, and instruct
lay rescuers and first responders in their use. Between March 1, 2010,
and Feb. 28, 2011, 3,928 AEDs were placed and 28,776 people were
trained in their use.
Therefore, ENA respectfully requests $8.927 million in fiscal year
2015 for the Rural and Community Access to Emergency Devices Program.
______
Prepared Statement of The Endocrine Society
The Endocrine Society is pleased to submit the following testimony
regarding fiscal year 2015 Federal appropriations for biomedical
research, with an emphasis on appropriations for the National
Institutes of Health (NIH). The Endocrine Society is the world's
largest and most active professional organization of endocrinologists
representing more than 17,000 members worldwide. Our organization is
dedicated to promoting excellence in research, education, and clinical
practice in the field of endocrinology. The Society's membership
includes thousands of basic and clinical scientists who receive Federal
support from the NIH to fund endocrine-related research on topics such
as diabetes, cancer, fertility, aging, obesity and bone disease. The
Society's membership also includes clinicians who depend on new
scientific advances to better treat and cure their patients' diseases.
As a result of Federal investment in endocrine research, individuals
with diabetes have made dramatic improvements in managing their
disease, and the obesity rate for children age 2 to 5 years old has
dropped 43 percent.\1,2\ The Endocrine Society recommends that the NIH
receive at least $32 billion in fiscal year 2015. This funding
recommendation represents the minimum investment necessary to avoid
further erosion of national research priorities and global preeminence,
while allowing the NIH's budget to keep pace with biomedical inflation.
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\1\ Casagrande et al., ``The Prevalence of Meeting A1C, Blood
Pressure, and LDL Goals Among People With Diabetes, 1988-2010.''
Diabetes Care, Aug 36;8 (2013) 2271-9.
\2\ Sabrina Tavernise, ``Obesity Rate for Young Children Plummets
43 percent in a Decade.'' The New York Times. Feb 25, 2014.
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Sustained investment by the United States Federal government in
biomedical research has dramatically advanced the health and improved
the lives of the American people. The United States' NIH-supported
scientists represent the vanguard of researchers making fundamental
biological discoveries and developing applied therapies that advance
our understanding of, and ability to treat human disease. In the past
year NIH funded scientists have made fundamental insights into how mild
traumatic brain injury causes brain damage; identified potential drug
targets for Parkinson's disease; and identified a safe and protective
candidate malaria vaccine.\3\ In the field of endocrinology, NIH-funded
researchers have made remarkable contributions in areas of critical
national interest, for example:
---------------------------------------------------------------------------
\3\ ``2013 Research Highlights''. December 23, 2013. http://
www.nih.gov/researchmatters/january2014/researchmatters2013recap.htm
Accessed March 23, 2013.
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--Endocrinologists have made insightful discoveries describing newly
understood contributors to body weight and obesity.\4\ Obesity
is a growing national concern, with related medical costs in
the United States as high as $190 billion in 2005 alone.\5\
---------------------------------------------------------------------------
\4\ Mathur et al., ``Methane and hydrogen positivity on breath test
is associated with greater body mass index and body fat.'' J Clin
Endocrinol Metab. 98;4 (2013) 698-702.
\5\ Cawley and Meyerhoefer. ``The medical care costs of obesity: an
instrumental variables approach.'' J Health Econ. 31;(2012) 219-30.
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--Endocrinologists have discovered that higher vitamin D levels are
associated with increased mobility and physical function in
older individuals. As the population of the United States
increasingly lives longer, this research has the potential to
dramatically improve the quality of life for Americans.\6\
---------------------------------------------------------------------------
\6\ Wohl et al., ``Vitamin D status is associated with functional
limitations and functional decline in older individuals.'' J Clin
Endocrinol Metab. 98;9 (2013) 1483-90.
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--Endocrinologists are also at the leading edge of research on
testosterone therapy and maintaining appropriate levels of sex
hormones. For instance, endocrinologists are investigating
links between testosterone levels and heart disease in men.\7\
---------------------------------------------------------------------------
\7\ Ruige et al., ``Beneficial and Adverse Effects of Testosterone
on the Cardiovascular System in Men.'' J Clin Endocrinol Metab. 98;11
(2013) 4300-10.
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These discoveries represent but a fraction of the contributions
made by endocrinologists and other NIH funded scientists in the past
year. The foundation for these research products are the NIH research
grants that support the basic and clinical research done by scientists.
Since 2004, the number of NIH research grants to scientists in the
United States has been declining. Consequently, the likelihood of a
scientist with a highly-regarded grant application successfully being
awarded a grant has dropped from 31.5 percent in 2000 to an historic
low of 16.8 percent in 2013.\8\ This means that experienced scientists
are increasingly spending time writing grant applications instead of
applying their expertise to productive research. Additionally, younger
scientists struggle to find a job in the United States that makes use
of the unique skills generated during graduate training.
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\8\ Salley Rockey, ``fiscal year 2013 By The Numbers: Research
Applications, Funding, and Awards,'' Rock Talk, January 10, 2014.
http://nexus.od.nih.gov/all/2014/01/10/fy2013-by-the-numbers/Accessed
March 20, 2014.
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The lack of sustained government support compounded by austerity
measures such as sequestration has created an environment that is
leading to a ``brain drain'' as brilliant scientists pursue other
careers or leave the United States to develop impactful research
products elsewhere. In 2013, the number of NIH supported scientists
declined significantly, with nearly 1,000 NIH scientists dropping out
of the workforce.\9\ NIH scientists run labs that support high-quality
jobs and education while generating breakthrough innovations. In 2011,
the NIH directly or indirectly supported over 432,000 jobs across the
country.\10\ As a result of sequestration, States such as Georgia and
Connecticut lost $62 million and $32 million respectively.\11\
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\9\ Jeremy Berg ``The impact of the sequester: 1,000 fewer funded
investigators.'' ASBMB Today. March (2014). https://www.asbmb.org/
asbmbtoday/201403/PresidentsMessage/Accessed March 20, 2014.
\10\ Everett Ehrlich ``Engine Stalled: Sequestration's Impact on
NIH and the Biomedical Research Enterprise.'' United for Medical
Research. (2012).
\11\ ``NIH State Information Factsheets.'' http://www.faseb.org/
Policy-and-Government-Affairs/Advocacy-on-Capitol-Hill/Advocacy-
Resources-for-Scientists/NIH-State-Information-Factsheets.aspx.
Federation of American Societies for Experimental Biology. Accessed
March 19, 2014.
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We may never be able to quantify the opportunities we have missed
to improve the health and economic status of the United States due to
persistent underinvestment in research. We do know however, that when
``laboratories lose financing, they lose people, ideas, innovations and
patient treatments.'' \12\ Based on the personal stories of researchers
who have been forced to curtail research programs, we know that
research programs to understand how genetics can influence heart
disease, develop therapeutic treatments for Parkinson's disease, and
evaluate the effect of metal contaminants on reproductive health; among
many others, are delayed or terminated.\13\
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\12\ Teresa K. Woodruff ``Budget Woes and Research.'' The New York
Times. September 10, 2013.
\13\ Sequester Profiles: How Vast Budget Cuts to NIH are Plaguing
U.S. Research Labs. United for Medical Research. http://
www.unitedformedicalresearch.com/advocacy_reports/sequestration-
profiles/Accessed March 20, 2014.
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As the world's largest source of funding for medical research, the
NIH is vitally important to the United States' global preeminence in
research. However, this global preeminence is being tested due to flat
funding that has reduced the inflation-adjusted budget of the NIH to a
level that is nearly 22 percent below the NIH budget in fiscal year
2003.\14\ As a consequence of this underinvestment, the United States'
global share of pharmaceutical industry output has declined, our global
share of biopharmaceutical patents has declined, and our trade balance
in pharmaceutical products is worsening.\15\ While the Bipartisan
Budget Act of 2013 and omnibus appropriations bill have provided some
much needed additional resources, overall levels of funding remain well
below the $32 billion required for adequate, sustainable growth in
biomedical research.
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\14\ ``Budget Cuts in 2013 Reduced Biomedical Research'' Federation
of American Societies
for Experimental Biology. http://www.faseb.org/
pdfviewer.aspx?loadthis=http%3A%2F%2F
www.faseb.org%2FPortals%2F2%2FPDFs%2Fopa%2F2014%2F1.21.14%2520NIH%2520Fu
nding
%2520Cuts%25202-pager.pdf Accessed March 19, 2014.
\15\ Atkinson et al., ``Leadership in Decline, Assessing U.S.
International Competitiveness in Biomedical Research.'' The Information
Technology and Innovation Foundation and United for Medical Research.
May 2012.
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We live during an age of tremendous scientific opportunity that can
only be realized through Federal funding of biomedical research.
Researchers are only beginning to harness the power of big data to
solve complicated problems. Innovative new experiments and clinical
research hold promise to solve some of the United States' greatest
medical challenges and discover new ways to improve our quality of
life. Government support is critical to these opportunities, and we
encourage the Appropriations Committee to actively support promising
and innovative research.
As the Appropriations Committee considers funding for the NIH, the
Endocrine Society also asks the Committee to encourage the NIH to look
at ways to increase data reporting to address gaps in gender and sex
differences in research. Sex differences need to be acknowledged as a
critical biological variable.\16\ In addition to including more women
in clinical research, the Endocrine Society believes sex differences
should be c as part of the design of all basic biological studies and
clinical research. If the NIH required researchers to consider sex
differences in grant applications when appropriate, and incorporate
data on sex as a biological variable in animal and human studies, more
appropriate conclusions could be drawn from basic research, and
clinical research would provide more representative data on safety and
efficacy of drugs.\17\
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\16\ Woodruff et al., ``'Leaning in' to Support Sex Differences in
Basic Science and Clinical Research.'' Endocrinology. 155;4 (2014)
1181-3
\17\ Kim et al., ``Sex Bias in Trials and Treatment Must End.''
Nature. 465;7299 (2010) 688-9.
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The Endocrine Society remains deeply concerned about the future of
biomedical research in the United States without sustained support from
the Federal government. Flat funding in recent years, combined with the
impact of sequestration, threaten the Nation's scientific enterprise
and make adequate fiscal year 2015 appropriations for the NIH
increasingly important. The Society strongly supports increased Federal
funding for biomedical research in order to provide the additional
resources needed to enable American scientists to address scientific
opportunities and maintain the country's status as the preeminent
research engine. The Endocrine Society therefore asks that the NIH
receive at least $32 billion in fiscal year 2015.
[This statement was submitted by Teresa K. Woodruff, PhD,
President, The Endocrine Society.]
______
Prepared Statement of the Entomological Society of America
The Entomological Society of America (ESA) respectfully submits
this statement for the official record in support of funding for
insect-borne disease research at the U.S. Department of Health and
Human Services (HHS). ESA requests a robust fiscal year 2015
appropriation for the National Institutes of Health (NIH), including
increased funding for insect-borne disease research at the National
Institute of Allergy and Infectious Diseases (NIAID). The Society also
supports increased investment in the core infectious diseases budget
and the global health budget within the Centers for Disease Control and
Prevention (CDC) in order to fund scientific activities related to
vector-borne diseases.
Advances in the biological sciences, including the field of
entomology, help to address some of our most pressing societal needs
related to environmental and human health. Certain species of insects
carry, spread, and transmit an array of infectious diseases that
threaten populations across the globe, including those in the United
States as well as U.S. military personnel undertaking missions abroad.
Insect-borne diseases can present an especially challenging health
problem; few vaccines have been developed against them, and insects are
often difficult to control and can develop resistance to insecticides.
The risk of emerging infectious diseases grows as global travel becomes
easier and environmental factors continue to change. For example, West
Nile virus, which is transmitted by mosquitoes and was not present in
the U.S. before 1999, infected 5,674 Americans in 2012.\1\
Entomological research to understand the biological relationship
between insect vectors and the infectious diseases they carry--such as
dengue, malaria, West Nile virus, and Lyme disease--can significantly
contribute to our ability to monitor and predict outbreaks, prevent
disease spread and transmission, and more reliably diagnose and treat
infection. Given the important role that insect vectors play in
impacting human health, ESA urges the subcommittee to support vector-
borne disease research programs that incorporate the entomological
sciences as part of a comprehensive approach to addressing infectious
diseases.
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\1\ CDC DVBD factsheet: http://www.cdc.gov/ncezid/dvbd/pdf/
dvbd_factsheet.pdf.
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NIH, the Nation's premier medical research agency, advances human
health by funding research on basic human biology and disease and the
development of prevention and treatment strategies. In fiscal year
2012, about 84 percent of NIH funding was competitively awarded to
scientists at approximately 2,500 universities, medical schools, and
other research institutions across the Nation. As one of NIH's 27
institutes and centers, NIAID conducts and supports fundamental and
applied research related to the understanding, prevention, and
treatment of infectious, immunologic, and allergic diseases. One
example of NIAID-funded research on infectious diseases is a recent
study examining the mechanism by which certain species of mosquitoes
known to transmit dengue and malaria are attracted to humans. The
scientists discovered that specific types of nerve cells in the insects
act as sensitive detectors of human odors. With this knowledge, the
researchers were able to identify safe and natural chemical compounds
with the potential to neutralize or overwhelm the specific insect nerve
cells, a discovery that could have implications for the control of
mosquitoes and their associated diseases.\2\ In another recent study
supported by NIAID, researchers determined that live, disease-free
ticks can be used as a safe tool for testing for the presence of Lyme
disease bacteria in patients who have completed antibiotic therapy.\3\
To ensure funding for future groundbreaking projects like these, ESA
requests increased funding for NIAID and encourages the committee to
support insect-borne disease research at NIH.
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\2\ Tauxe, GM, et al. Targeting a dual detector of skin and CO2 to
modify mosquito host seeking. Cell (2013).
\3\ Marques, A, et al. Xenodiagnosis to detect Borrelia burgdorferi
infection: A first-in-human study. Clinical Infectious Diseases (2014).
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CDC, serving as the Nation's health protection agency, conducts
science and provides health information to prevent and respond to
infectious diseases and other global health threats, whether naturally
arising or related to bioterrorism. Within the core infectious diseases
budget of CDC, the Division of Vector-Borne Diseases (DVBD) seeks to
protect our Nation from the threat of viruses and bacteria transmitted
primarily by mosquitoes, ticks, and fleas. DVBD's mission is carried
out by a staff of experts in several scientific disciplines, including
entomology. For example, among the activities supported by DVBD are the
ArboNET surveillance system for mosquito-borne diseases and the TickNET
system for tick-borne diseases. ArboNET is a nationwide network that
monitors West Nile virus and other diseases through activities such as
the collection and testing of mosquitoes, and TickNET is a partnership
between 16 States to track tick-borne-diseases like Lyme disease and
test preventions. Furthermore, a component of CDC's global health
budget supports activities on parasitic diseases and malaria; this
includes the maintenance of a global reference insectary that houses
colonies of mosquitoes from around the world to be used by the agency
for studies on malaria transmission. Given the important contributions
of CDC, ESA requests that the committee provide increased support for
CDC programs addressing vector-borne diseases and malaria.
ESA, headquartered in Annapolis, Maryland, is the largest
organization in the world serving the professional and scientific needs
of entomologists and individuals in related disciplines. Founded in
1889, ESA has nearly 7,000 members affiliated with educational
institutions, health agencies, private industry, and government.
Members are researchers, teachers, extension service personnel,
administrators, marketing representatives, research technicians,
consultants, students, pest management professionals, and hobbyists.
Thank you for the opportunity to offer the Entomological Society of
America's support for HHS research programs.
[This statement was submitted by Frank G. Zalom, PhD, President,
Entomological Society of America.]
______
Prepared Statement of Families & Friends of Care Facility Residents
Chairman Harkin, Ranking Member Moran, Members of the Subcommittee:
Thank you for this opportunity to provide information to the Senate
Appropriations Subcommittee on Labor, Health & Human Services Education
& Related Agencies. This is a letter-request that the Subcommittee
cease funding Federal programs which use public funds to achieve public
policies of deinstitutionalization of persons identified as benefiting
from congregate (institutional) care, typically those with severe forms
of cognitive-developmental disabilities.
I am the mother and co-guardian of an adult son, aged 45, who from
birth has lived with the effects of severe brain injuries. John is a
large, mobile and nonverbal man with pica behavior who functions on the
mental level of a young toddler. Our son has slight or little awareness
of danger and his direct care is beyond our family's capacities. For
many years John's safe home has been a state-operated congregate care
program, an intermediate care facility for persons with intellectual
disabilities (formerly known as a medical diagnosis of mental
retardation). The future viability of John's home is in jeopardy due to
the undermining work of federally funded entities and programs in the
U.S. Department of Health and Human Services and the Department of
Justice/Civil Rights Division.
I represent as public affairs chairman Families and Friends of Care
Facility Residents (FF/CFR), Arkansas' statewide parent-guardian
association. FF/CFR is an all-volunteer organization; we employ no
lobbyist; we receive no public funds.
I have reviewed the testimonies of Department of Health and Human
Services representatives presented before this subcommittee for the
past several years. DHHS did not disclose that the Department is
engaged in a social experiment to dismantle the States' residential
safety net programs for persons who have been adjudicated incompetent
and that the Department is using public funds to support organizations
which lobby decision-makers to deinstitutionalize persons who are
without self-preservation skills, who cannot assist in their own care
and who cannot communicate their hurts and needs or who can do so only
in limited ways.
The following are examples of how government dollars are spent in
the wrong way by the Department of Health and Human Services:
(1) National Council on Disability (NCD), an independent Federal agency
engaged in disability policy recommendations.
On Tuesday, October 23, 2012, the National Council on Disability
(NCD) released its policy project--``Deinstitutionalization: Unfinished
Business.'' The press release read: ``NCD Launches Toolkit to Speed
Closure of State-Run Institutions.'' Although NCD is a Federal agency,
it has no congressional oversight and is not accountable for its
actions, except as Congress may provide. Prior to releasing its
deinstitutionalization policy recommendations and documents, there were
no public hearings or Notice to those most affected. There was no
public in-put process. Arkansas' statewide parent-guardian association,
FF-CFR, is comprised of volunteer advocates who work in behalf of the
vulnerable people who live and receive services at our State's five
human development centers (HDCs). Arkansas' five HDCs provide 24/7 care
for 950 individuals. Over 64 percent of the residents function in the
profound range of cognitive ability. We object to use of a Federal
agency/Federal funds to promote public policies which are harmful. We
object to empowerment of Federal agencies to formulate public policies
in camera without public hearings and without the easy involvement of
those most affected. NCD inappropriately collaborates with others in
promoting its national de-institutionalization agenda out of the public
eye.
REQUEST: Public funds should not be used to support National
Council on Disability and its extreme agendas. Please discontinue its
funding.
(2) Programs funded under Public Law 106 402, Developmental
Disabilities Assistance and Bill of Rights Act (DD Act). The DD
Act funds three discretionary programs which operate in every
State: (1) State Councils on Developmental Disabilities, (2)
Protection & Advocacy Systems for Developmental Disabilities
(P&As) and (3) University Centers for Excellence in
Developmental Disabilities. The DD Act also funds a fourth
program, Projects of National Significance. The four DD Act
programs are administered by DHHS/Adm. on Community Living/Adm.
on Intellectual-Developmental Disabilities
Through litigation, lobbying and other strategies, DD Act programs
and their national organizations have used and are using public funds
to achieve forced-deinstitutionalization of individuals with profound
cognitive-developmental disabilities from their congregate care homes
and the closures of Medicaid-certified public facilities for these
individuals with profound disabilities. The DD Act programs'
administrative office (Adm-IDD) has embraced an extreme agenda and is
not responsive to the complaints and concerns of families, friends and
legal guardians of individuals with disabilities who require close 24/7
care.
The DD Act was last re-authorized in 2000; its current
authorization ended in 2007. At the last reauthorization, there was no
public hearing and no opportunity to object to the ways in which
grantees (State Councils on DD, Protection & Advocacy (P&A) systems and
University Centers on DD) were collaborating with each other and with
others for use of Federal appropriations to undermine and close
congregate care programs for those persons with the most severe forms
of developmental disabilities. There have been no hearings on
reauthorization of the DD Act where families might participate and
provide information about and objections to the programs' activities.
The Arkansas DD Act P&A system has: (1) joined with Arc in a Federal
lawsuit to close all Arkansas human development centers (HDCs), (2)
brought 3 Federal lawsuits in succession seeking to change our AR HDC
admission and discharge policies naming HDC residents as plaintiffs
without notice or consent of their legal guardians (in two of the cases
the AR P&A sought class certification with no opportunity for residents
to opt out of the class); (3) filed a complaint with Civil Rights
Division-U.S. Dept. of Justice regarding care at our HDCs without
consulting families of HDC residents and cheered in the media when DOJ
brought a systems-change lawsuit against all HDCs; (4) testified
against AR HDC funding before State legislative panels; (5) organized a
public rally calling on the AR Governor to close one of our HDCs; (6)
denigrated congregate care and AR HDC programs in the media during a
Federal trial, USA v. State of AR (Conway HDC); (7) provided erroneous
information to AR policy makers regarding cost of care and the U.S.
Supreme Court decision in Olmstead v. L. C. (119 S. Ct. 2176); and (8)
sent financial support to its Washington D.C.-based national
organization, National Disability Rights Network (NDRN), an
organization with no oversight which lobbies the Administration,
Congress and CMS, collaborating with other organizations in campaigns
to shift Medicaid funding from congregate care programs for persons
with life-long cognitive and other developmental disabilities. Most
recently (January & February, 2014), the Arkansas DD Act P&A in
testimony before a legislative panel and in a letter to members of the
State legislature worked against funding for capital improvements at
our State's five human development centers. Families with whom I
correspond in other States report that DD Act programs have used grant
funds to fund other organizations to plan and lobby for the closure of
State-operated congregate care programs for individuals with cognitive-
developmental disabilities. In November and December, 2012 , the
national organizations for two DD Act programs (Association of
University Centers on Disabilities (AUCD) and protection and advocacy
(National Disability Rights Network--NDRN) led the work of lobbying to
prevent the mark-up of H.R. 2032 in the U.S. House Judiciary Committee.
Had 2032 passed, some egregious protection and advocacy activities
employing litigation as a tactic to undermine and close congregate care
centers might have been addressed and prohibited.
REQUEST: Public funds should not be used to support the DD Act
Programs' extreme agendas of deinstitutionalization. Please discontinue
funding the groups' harmful deinstitutionalization work.
(3) DHHS Financial incentive grants--Money Follows the Person (MFP),
Balance Incentive Payment Plan (BIP), Community First Choice
Option (CFCO)
Through generous financial incentive demonstration grants (Money
Follows the Person, Balance Incentive Plan, Community First Choice
Option), CMS is promoting thoughtless policies of de-
institutionalization for persons with developmental disabilities by
funding generous incentive grants for one needed program (home and
community based waiver care) but not another needed program (licensed
safety-net congregate care facilities). The majority of persons with
cognitive-developmental disabilities can and are being served through
States' home and community based wavier programs. There is no
``institutional bias'' in our State of Arkansas for persons with
developmental disabilities: 74.2 percent of Medicaid dollars are spent
on home and community based waiver programs. Over 4,000 individuals
with developmental disabilities are served in Arkansas' community-based
waiver programs versus approximately 950 residents in the State's
public safety-net institutions for people with developmental
disabilities. For clinically complex cases and for people with profound
cognitive-and other severe forms of developmental disabilities
requiring 24/7 supervision whose needs cannot be successfully met at
home, or whose families can no longer provide their care, the option of
institutional programs such as Arkansas' Human Development Centers
(HDCs) is life-saving. HDCs are cost-efficient and they also provide a
proven safe model of long term care. When all costs are taken into
account, there are no cost savings to shift from institutional care to
community care for this vulnerable population. Persons with little or
no awareness of danger who cannot or who cannot adequately communicate
their hurts and needs will be at greater risk of abuse, exploitation
and death when they are forced from their safe congregate care homes.
The testimony of Secretary HHS Kathleen Sebelius before House Committee
on Appropriations (April 25, 2013, ``Protecting Vulnerable
Populations'') does not comport with our family's experiences with the
outcomes of DHS/CMS financial incentive grants and other DHHS de-
institutionalization programs. The push by CMS to entice States through
financial rewards to shift from providing care for persons in
specialized residential programs does not comport with realities in the
field of long-term care. The American Medical Association (AMA) has
designated persons with intellectual--developmental disabilities
(formerly termed mental retardation) as a medically underserved
population. The AMA Policy (CMS Rep. 3-1-11) ``encourages support for
healthcare facilities whose primary mission is to meet the healthcare
needs of persons with profound developmental disabilities.'' The
National Crime Victimization Survey (Feb. 2014) found that
``Individuals with disabilities encountered violent crime at nearly
three times the rate of those in the general population . . . . . Those
with cognitive disabilities had the highest rate of victimization and
about half of violent crime victims with disabilities had multiple
conditions.''
The use by CMS of public funds--through financial incentive
grants--to reward States when they shift Medicaid long-term care
funding from institutional care programs to community programs which
generally have less oversight and accountability is misguided and
dangerous. Families of individuals who require close care had little or
no opportunity to review, comment and object that CMS incentive grants
favor one needed program over another critically needed program. The
extension of Federal funding for Money Follows the Person (MFP) grants
and Community First Choice Option (CFCO) are optional programs offered
to the States in the voluminous Affordable Care Act, inserted without
adequate review, without debate, and without adequate notice to
families most affected. Extension of MFP, BIP, and CFCO were created by
DHHS out of the public eye with inadequate opportunity for the public
to review, comment or object.
DHHS is too far removed from the realities which families
understand and which are based on their years of experiences with their
disabled family members.
REQUEST: Public funds should not be used to promote DHHS policies
of deinstitutionalization. Please address the unfair, unsafe CMS de-
institutionalization incentive grants.
summary
Policy decisions which destroyed the Nation's safety net programs
for persons with mental illness are now understood to be disastrous and
ill-conceived for a small but significant percent of persons living
with severe, chronic mental illness.
Please resist funding DHHS programs and policies which promote
harmful deinstitutionalization of persons with severest forms of
developmental disabilities. My son and his peers cannot appear before
committees, engage in protests or advocate for their health and safety.
Please use your powerful authority to direct DHHS to cease its partisan
use of public funds to achieve deinstitutionalization.
[This statement was submitted by Carole L. Sherman, Arkansas'
statewide parent-guardian association.]
______
Prepared Statement of the Federation of American Societies for
Experimental Biology
The Federation of American Societies for Experimental Biology
(FASEB) respectfully requests a minimum of $32 billion in fiscal year
2015 for the National Institutes of Health (NIH) within the Department
of Health and Human Services. Increasing the NIH budget to $32 billion
would support vital initiatives to train the next generation of
scientists, and fund at least 600 additional competing research grants.
FASEB, a federation of 26 scientific societies, represents more
than 115,000 life scientists and engineers, making it the largest
coalition of biomedical research associations in the United States. Our
mission is to advance health and welfare by promoting progress and
education in biological and biomedical sciences.
NIH has produced an outstanding legacy of discoveries that have
generated new knowledge, improved health, and saved lives. Many of
these advances arose from investigations designed to explain basic
molecular, cellular, and biological mechanisms. In addition, research
supported by NIH led to innovative technologies and created entirely
new global industries resulting in economic growth and new, high-tech
jobs.
As a result of our prior investment in NIH, we have reduced the
death toll of many diseases and reduced the disability and suffering
from many others. For example, U.S. death rates from heart disease and
stroke have decreased by more than 60 percent in the last 50 years, the
rate of acute hepatitis B has been reduced by 80 percent since the
1980's, and the proportion of older people with chronic disabilities
has dropped by one-third over the last quarter century. Research funded
by NIH helped develop new treatments that have significantly reduced
the transmission of human immunodeficiency virus from mother to child
and provided insights into traumatic brain injury. In addition, with
the completion of the Human Genome Project and subsequent technological
advances in rapidly sequencing DNA, scientists have been able to
identify genes that are responsible for more than half of the 7,000
rare diseases known to affect humans and evaluate the genetic
composition of various cancers with the hopes of pinpointing the most
effective therapy for each individual patient.
NIH-supported research is continuing to produce the insights that
are needed for tomorrow's improvements in health and clinical care.
Recent discoveries include:
--Advances in Treating Melanoma: Years of basic research supported by
NIH have provided insights into biological changes that occur
in the development of cancer, including the observation that a
protein called b-Raf appears in a mutated form in more than 50
percent of melanomas, the most aggressive form of skin cancer.
Studies showing that this protein plays a critical role in
melanoma led pharmaceutical companies to develop drugs to
inhibit mutant b-Raf. These drugs can s improve quality of life
and prolong survival in the majority of patients with advanced
melanoma who harbor b-Raf mutations. Since most of these
patients eventually relapse and die from their disease, studies
are underway to understand why melanomas become resistant to
treatment. It is hoped that this will lead to new treatments
that can overcome or bypass resistance, with the goal of
achieving long-term remissions and cures.
--Developing Structure-Based Vaccines: Respiratory syncytial virus
(RSV) is responsible for nearly 7 percent of deaths of infants
under 12 months of age. It also causes death and disability in
the elderly. NIH-funded research has illuminated many aspects
of RSV infection and pathogenesis, yet an effective vaccine has
remained elusive. Recently, investigators made a breakthrough
by determining the three-dimensional structure of an RSV
protein required for cell entry. This structural information
was then used to design a stabilized vaccine antigen that
elicited high titers of protective antibodies in mice and non-
human primates. In the next few years, this promising vaccine
candidate will be tested in clinical trials, and it is hoped
that this structure-based approach to vaccine design will be
successful for other viruses, such as HIV-1.
--Testing New Anti-Inflammatory Drugs: In the 1990's, NIH supported a
few academic researchers to study molecules called glycans for
their function in inflammation, the process the body uses to
fight infection. In 2013, these studies came to fruition with
the first tests of a new, glycan-based anti-inflammatory drug.
In an initial test to fight inflammation during the painful
crises that occur in sickle cell disease, both children and
adult patients who got this treatment had shorter disease
crises, spent less time in the hospital, and needed fewer
narcotics for pain relief. This new drug that will benefit tens
of thousands of people in the U.S. each year could never have
been developed without NIH's investment in exploratory basic
research.
--Harnessing the Immune System to Fight Cancer: Science magazine
named cancer immunotherapy--using the immune system to attack
tumors--the 2013 Breakthrough of the Year. The early work that
led to the development of immunotherapy was made possible by
NIH-funded research on many basic biological processes,
including the biology of T cells, a family of cells that are
critical to the immune system. Researchers discovered that when
a certain receptor on the outside of T cells is activated,
cells cannot mount an effective immune response. They then
reasoned that if an antibody blocked the activation of this
receptor, T cells could be induced to attack tumor cells.
Ongoing clinical trials testing antibody immunotherapies in
individuals found that tumors shrunk by almost 50 percent in 31
percent of those with melanoma and 29 percent in those with
kidney cancer.
Further Progress Depends on Sustained Investment
Research supported by NIH advances our understanding of the nature
of living systems and enables us to apply that knowledge to the
improvement of human health. In a recent op-ed in The Washington Post,
NIH Director Francis S. Collins, MD, PhD, wrote, ``Biomedical research
is at a critical juncture--a moment of exceptional opportunities that
demand exceptional attention if their promise is to be fully
realized.'' \1\ But without continued support for basic biomedical
research, Dr. Collins fears that we will miss out on new discoveries
that will give us the next generation of cures and therapies for such
conditions as Parkinson's disease and Alzheimer's disease, as well as a
universal vaccine to protect adults and children against all flu
strains without needing an annual shot.
---------------------------------------------------------------------------
\1\ Collins, F. (2013, December 24). Investing in the Nation's
Health at NIH. Washington Post.
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While the opportunities to increase our understanding of diseases
and develop new therapies are unprecedented, a decade of flat-funding--
followed by $1.55 billion in sequestration cuts in fiscal year 2013--
have taken a significant toll on NIH's ability to support research. In
constant dollars (adjusted for inflation), the fiscal year 2013 budget
for NIH was the lowest in thirteen years. The number of competing R01-
equivalent grants, the primary mechanism for supporting investigator-
initiated research, awarded each year fell by 34 percent between 2003
and 2013. The current situation is decimating the ranks of our
scientific workforce, causing productive scientists to seek alternative
careers and discouraging talented trainees from pursuing jobs in
academic research. It surrenders our future leadership in medical
research.
As a first step toward a multi-year program of sustainable growth,
FASEB recommends a minimum of $32 billion for NIH in fiscal year 2015.
Thank you for the opportunity to offer FASEB's fiscal year 2015 funding
recommendation for NIH.
______
Prepared Statement of Cheryl Felak
Dear Committee Members: Thank you very much for the opportunity to
submit personal and professional testimony to this committee.
I am writing as a healthcare professional with an abundance of
experience working with clients and family members who experience life
with developmental disabilities. I am also the parent of a young man
who has profound developmental disabilities due to a rare genetic
condition which is similar to pediatric Alzheimer's.
I would like you to be aware that many of the advocacy agencies in
this country (The Arc and it's many State and local chapters),
Developmental Disability Councils and affiliates, all who receive
Federal funds for advocacy, are forgetting that our citizens with
developmental disabilities live on a continuum and have a large
variation in support needs.
It is shameful that these so-called advocacy groups forget about
those with the most profound needs, misinterpret the 1999 U.S. Supreme
Court Olmstead decision on choice and community, and force their
opinions regarding these issues discriminatory practices.
It is a fact that people need communities--yet why are these so
called advocacy groups allowed to determine what ``community'' is for
those with developmental disabilities. Rather than allowing choice and
opportunities, they are restricting choice and opportunities to this
group of people. This is discrimination.
I am not aware of any other population which has ``community''
defined for them, which has funds for housing, medical care, education,
vocational support tied to the artificial definition of ``community''
which is made up for people with developmental disabilities.
I believe it is time to go back and really read the Olmstead
Decision--not just take for granted what is heard because what is heard
is not what the decision States. We need to honor this decision and
stop discriminating against our most vulnerable citizens.
Thank you very much.
[This statement was submitted by Cheryl Felak, RN, BSN, Because We
Care--Beyond Inclusion.]
______
Prepared Statement of the Friends of the Health Resources and Services
Administration
The Friends of HRSA is a non-partisan coalition of more than 170
national organizations representing millions of public health and
healthcare professionals, academicians and consumers invested in HRSA's
mission to improve health and achieve health equity. For fiscal year
2015, we recommend restoring HRSA's discretionary budget authority to
the fiscal year 2010 level of $7.48 billion. We are deeply concerned
that since fiscal year 2010, HRSA's discretionary budget authority has
been cut by 19 percent in nominal dollars and 25 percent when adjusted
for inflation. Funding for HRSA is far too low and keeping austerity
measures in place will threaten the agency's ability to address the
present and growing health needs of the U.S. Of additional concern,
cuts will be compounded by the fact that multiple mandatory programs
are set to expire at the end of fiscal year 2015. In the absence of
continued mandatory funding for the National Health Service Corps Fund
and Community Health Center Fund, the committee will be faced with
addressing these shortfalls in the following Labor-HHS-Education
appropriations bill.
The Nation faces a shortage of health professionals and continues
to experience an ever growing, aging and increasingly diverse
population, alongside health professionals that are nearing retirement
age. Additionally, national estimates of workforce shortages are often
masked by significant distributional disparities--particularly in rural
and certain inner-city populations that experience greater shortages.
By restoring funding to HRSA, the agency will be able to more
effectively fill the primary and preventive care gaps for people living
outside of the medical and economic mainstream through supporting a
well prepared workforce and high-quality health services.
HRSA operates programs in every State and U.S. territory and is a
national leader in improving the health of Americans. HRSA programs
have reduced AIDS-related deaths through providing drug treatment
regimens for people living with HIV and have the potential to prevent
the spread of HIV by 96 percent by ensuring that people living with HIV
have access to regular care and adhere to their antiretroviral
medications. Less than 10 percent of people who experience a cardiac
arrest outside of a hospital setting survive. HRSA provides rural
communities with training and access to emergency devices which can
more than double a patient's chance of survival. HRSA has contributed
to the decrease in infant mortality rate, a widely used indicator of
the Nation's health, which is now at an all-time low. Most recently,
preliminary data indicates that the infant mortality rate for black
infants has decreased, resulting in a narrowing of the gap that exists
between racial groups.
Now is the time to make a strong investment in a robust workforce
and to improve access to care to continue achieving the health
improvements HRSA has made and to pave the way for new achievements.
The Nation only stands to benefit from a healthier population through a
thriving workforce and reduced healthcare costs. Our recommendation is
based on the need to continue improving the health of Americans by
supporting critical HRSA programs including:
--Health professions programs support the education and training of
primary care physicians, nurses, oral health professionals,
optometrists, physician assistants, nurse practitioners,
clinical nurse specialists, public health personnel, mental and
behavioral health professionals, pharmacists and other allied
health providers. With a focus on primary care and training in
interdisciplinary, community-based settings, these are the only
Federal programs focused on filling the gaps in the supply of
health professionals, as well as improving the distribution and
diversity of the workforce so health professionals are well-
equipped to care for the Nation's growing, aging and
increasingly diverse population. Additionally, HRSA provides
interdisciplinary training to health professionals to
accurately screen, diagnose and treat children with autism and
other developmental disabilities.
--Primary care programs support nearly 9,200 service delivery sites
in every State and territory, improving access to preventive
and primary care to more than 21 million patients in
geographically isolated and economically distressed
communities. Close to half of the health centers serve rural
populations. The health centers coordinate a full spectrum of
health services including medical, dental, behavioral and
social services--often delivering the range of services in one
location. In addition, health centers target populations with
special needs, including agricultural workers, homeless
individuals and families and those living in public housing.
Following health insurance reform in Massachusetts, health
centers experienced a substantial increase in newly-insured
patients. We expect the same will be true nationally, as health
insurance expands to millions of Americans who were previously
uninsured. Health centers and other programs administered by
HRSA will remain vital sources of care for patients and
continue to reduce costs to the health system.
--Maternal and child health programs, including the Title V Maternal
and Child Health Block Grant, Healthy Start and others, support
initiatives designed to promote optimal health, reduce
disparities, combat infant mortality, prevent chronic
conditions and improve access to quality healthcare for 43
million women and children. MCH programs help assure that
nearly all babies born in the U.S. are screened for a range of
serious genetic or metabolic diseases and that a community-
based system of family centered services is available for
coordinated long-term follow up for babies with a positive
screen and for all children with special healthcare needs.
--HIV/AIDS programs provide the largest source of Federal
discretionary funding assistance to States and communities most
severely affected by HIV/AIDS. The Ryan White HIV/AIDS Program
delivers comprehensive care, prescription drug assistance and
support services for more than half a million low-income people
impacted by HIV/AIDS, which accounts for about half of the
total population living with the disease in the U.S.
Additionally, the programs provide education and training for
health professionals treating people with HIV/AIDS and work
toward addressing the disproportionate impact of HIV/AIDS on
racial and ethnic minorities.
--Family planning Title X services ensure access to a broad range of
reproductive, sexual and related preventive healthcare for over
5 million poor and low-income women, men and adolescents at
nearly 4,400 health centers nationwide. Healthcare services
include patient education and counseling, cervical and breast
cancer screening, sexually transmitted disease prevention
education, testing and referral, as well as pregnancy diagnosis
and counseling. This program helps improve maternal and child
health outcomes and promotes healthy families. Often, Title X
service sites provide the only continuing source of healthcare
and education for many individuals.
--Rural health programs improve access to care for the nearly 50
million people living in rural areas that experience a
persistent shortage of healthcare services. The Office of Rural
Health Policy serves as the Nation's primary voice for programs
and research on rural health issues. Rural Health Outreach and
Network Development Grants, Rural Health Research Centers,
Rural and Community Access to Emergency Devices Program and
other programs are designed to support community-based disease
prevention and health promotion projects, help rural hospitals
and clinics implement new technologies and strategies and build
health system capacity in rural and frontier areas.
--Special programs include the Organ Procurement and Transplantation
Network, the National Marrow Donor Program, the C.W. Bill Young
Cell Transplantation Program and National Cord Blood Inventory.
These programs maintain and facilitate organ marrow and cord
blood donation, transplantation and research, along with
efforts to promote awareness and increase organ donation rates.
Special programs also include the Poison Control Program, the
Nation's primary defense against injury and death from
poisoning. For every dollar spent on the poison center system,
$13.39 is saved in medical costs and lost productivity,
totaling more than $1.8 billion every year in savings.
While the Bipartisan Budget Act of 2013 and Consolidated
Appropriations Act of 2014 provided modest and temporary relief from
sequestration, austerity measures remain firmly in place, which pose
serious threats for the viability of HRSA's important programs and
compromise the agency's ability to address our Nation's health needs.
We urge you to consider HRSA's central role in strengthening the
Nation's health and advise you to adopt our fiscal year 2015 request of
$7.48 billion for HRSA's discretionary budget authority. Thank you for
the opportunity to submit our recommendation to the subcommittee.
______
Prepared Statement of Friends of the National Institute of Child Health
and Human Development
My name is Kate Ryan. I currently serve as Co-Chair of the Friends
of the National Institute of Child Health and Human Development
(NICHD). On behalf of the Friends, I urge the Labor, Health and Human
Services, Education Appropriations Subcommittee to support at least $32
billion for the NIH, including $1.37 billion for NICHD for fiscal year
2015. Our coalition includes over 100 organizations representing
scientists, physicians, healthcare providers, patients and parents
concerned with the health and welfare of women, children, families, and
people with disabilities. We are pleased to support the extraordinary
work of the Eunice Kennedy Shriver National Institute of Child Health
and Human Development (NICHD).
Since its establishment in 1963, NICHD has achieved great success
in meeting the objectives of its broad biomedical and behavioral
research mission, which includes research on child development before
and after birth; maternal, child, and family health; learning and
language development; women's health and reproductive biology;
population issues; and medical rehabilitation. With sufficient
resources, NICHD could build upon the promising initiatives described
in this testimony and produce new insights into human development and
solutions to health and developmental problems throughout the world,
including for women, children and families in your districts.
Scientific breakthroughs supported by NICHD serve to prevent and treat
many of the Nation's most devastating health problems including infant
mortality and low birthweight, birth defects, intellectual and
developmental disabilities, and the reproductive and gynecologic health
of women throughout their lifespan, among others. Some of these
research areas are described below.
Preterm Birth.--NICHD supports a comprehensive research program to
study the causes of preterm birth and prevention strategies and
treatment regimens. Pre-term birth costs our Nation $26 billion
annually and is a leading cause of infant mortality and intellectual
and physical disabilities. Continued prioritization of extramural
preterm birth prevention research, the Maternal-Fetal Medicine Units
Network, the Neonatal Research Network and intramural research program
related to prematurity are necessary to further this work. Resources
also should be available to support transdisiplinary science as
recommended in NICHD's Scientific Vision to study and identify the
complex causes of preterm birth.
NICHD supports research on the causes of preterm birth with the
goal of discovering effective ways to prevent it. In the U.S., the rate
of preterm birth is approximately 12 percent, one of the highest rates
in all industrialized countries, resulting in neonatal death, infant
mortality and severe neurological disability, including cerebral palsy,
mental retardation, and visual/auditory problems. Preterm birth also
significantly impacts families emotionally and financially. Although
research has identified some factors that influence preterm birth
(e.g., multiple gestation, infections, diabetes, high blood pressure),
it cannot be fully explained by physical health. There is growing
evidence of the role of psychological factors such as pregnancy-related
anxiety and stress, behavioral issues such as substance abuse, and
sociological issues such as cultural disparities. Thus, support is
needed for research on the complex interaction of factors including
psychological, behavioral, social, and environmental factors in
addition to genetic and biological influences, with the ultimate goal
of developing efficacious interventions to decrease this country's
epidemic of babies being born far too soon.
National Children's Study (NCS).--The NCS is the largest and most
comprehensive study of children's health and development ever planned
in the United States. The Friends of NICHD thank the Committee for its'
longstanding support of the NCS. The Friends look forward to roll-out
of the main study that includes a science-based design and recruitment
strategy. When fully implemented, this study will inform the work of
scientists in universities and research organizations, helping them
identify precursors to disease and to develop new strategies for
prevention and treatment. Identifying the root causes of many childhood
diseases and conditions, including preterm birth, developmental delay,
asthma, obesity, heart disease, injury and diabetes, will reduce
healthcare costs and improve the health of children. NCS also provides
an opportunity to collect data on social and behavioral aspects of
child and adolescent health, such as important information on the
sexual and reproductive health of adolescents
Contraceptive Research and Development.--NICHD's Contraceptive
Discovery and Development Branch supports basic, applied and clinical
research on contraceptive methods, including mechanisms of action, the
effects of contraceptive hormones and drugs, and optimal formulations
of contraceptive agents. Through its investment in contraceptive
evaluation research, NICHD plays a key leadership role in ensuring
acceptability and effective use of existing products in various
settings and populations and in addressing behavioral issues related to
fertility and contraceptive use. Specific opportunities and research
priorities in the area of contraceptive evaluation include evaluation
of the safety and effectiveness of hormonal contraceptive options for
women who are overweight or obese. The Institute's investment in
contraceptive research and development is critical for producing new
contraceptive modalities that are more effective, affordable,
acceptable, and easier to deliver, by, for example, offering couples
options with fewer side-effects and addressing women's other concerns
about contraceptive use. Specific opportunities and research priorities
in the area of contraceptive research and development include the need
for non-hormonal contraception, pericoital contraception, and
multipurpose prevention technologies that would prevent both pregnancy
and sexually transmitted infections.
Reproductive Sciences.--Through its investment in reproductive
science, NICHD conducts research to improve women's health by
developing innovative medical therapies and technologies and improving
existing treatment options for gynecological conditions affecting
overall health and fertility. The Institute's reproductive science
research makes a vital contribution to women's health by focusing on
serious conditions that have been overlooked and underfunded, despite
the fact that they impact many women. Future work could focus on
infertility research into the need for treatments for disorders such as
endometriosis, polycystic ovarian syndrome (PCOS) and uterine fibroids
which can prevent couples from achieving desired pregnancies.
Pelvic Floor Disorders Network (PFDN).--Female pelvic floor
disorders (PFD) represent an under-appreciated but major public health
burden with high prevalence, impaired quality of life and substantial
economic costs affecting approximately 25 percent of American women.
The PFDN is conducting research to improve treatment of these extremely
painful gynecological conditions. Current research is aimed at
improving female urinary incontinence outcome measures and ensuring
high quality patient-centered outcomes.
Development of the Research Workforce.--Adequate levels of research
require a robust research workforce. The years of training combined
with uncertainty in getting grant funding are huge disincentives for
students considering a career in bio-medical research. This has
resulted in a huge gap between the too-few women's reproductive health
researchers being trained and the immense need for research. NICHD's
Women's Reproductive Health Research (WRHR) Program and Reproductive
Scientist Development Program (RSDP), both aimed at obstetrician-
gynecologists to further their education and experience in basic,
translational, and clinical research, provide training grants to
hundreds of researchers and provide new insight into a host of
diseases, such as ovarian cancer. Continued investment in these
training programs is critical to helping ensure future scientific
advances in women's health research.
Population Research.--The NICHD Population Dynamics branch supports
a diverse portfolio of scientific research and research training
programs, exploring the social, economic and health-related impacts of
population change on families, children, and communities. The branch is
well respected for investing wisely in the development of longitudinal,
representative surveys, providing scientists with reliable data that
can be used to examine the influence of early life course events on
long-term health and achievement outcomes in particular. As an example,
in 2012, NICHD-supported demographers using data from the Panel Study
of Income Dynamics survey found that growing up in poor neighborhoods
throughout the entire childhood life course can have a devastating
effect on educational attainment. In another study, using data from the
National Study of Adolescent Health, researchers found that women who
are overweight or obese years during the transition from adolescence to
adulthood are more likely to later deliver babies with a higher birth
weight, putting the next generation at a higher risk of obesity-related
health outcomes.
Sex Differences in Research.--The Friends encourages NICHD to look
at ways to increase data reporting to address gaps in gender and sex
differences in research. Sex differences need to be acknowledged as a
critical biological variable. In addition to including more women in
clinical research, we believe sex differences should be included as
part of the design of all basic biological studies and clinical
research. If the researchers were to consider sex differences in the
design of basic science studies, and incorporate data on sex as a
biological variable in animal and human studies, more appropriate
conclusions could be drawn from basic research, and clinical research
would provide more representative data on safety and efficacy of drug.
Clinical Trials in Pregnant Women.--Pregnant women have
historically been excluded from most research trials due to concern
that trial participation could harm the fetus. Although there has been
substantial progress in the inclusion of women in federally funded
research, pregnant women are still excluded, even from research that
would advance our knowledge of medical conditions and treatments in
pregnancy. Mindful of the important considerations of clinical trials
on pregnant women, we support establishment of a Federal work group to
propose how clinical research might be done appropriately in this area.
Data on Pediatric Enrollment in NIH Trials.--NIH policy mandates
the inclusion of women, minorities, and children in clinical trials
whenever appropriate. While NIH collects enrollment data on sex/gender
and race, it does not collect enrollment data broken down by age. We
urge NIH, with leadership from NICHD, to improve data collection and
reporting on pediatric enrollment sufficient to determine if children
are appropriately represented in trials with relevance to child health.
Best Pharmaceuticals for Children Act (BPCA).--NICHD funds
meaningful research into pediatric pharmacology through the BPCA
program. This program provides for the study of drug products that are
important to children but have been inadequately studied in pediatric
populations. We urge continued funding and support for this important
research, as well as for training the next generation of pediatric
clinical investigators.
Brain Development.--Research on learning disabilities--neurological
disorders that can make it difficult to acquire certain academic and
social skills--shows that they can be prevented through effective
evidence-based programs in school and that when children improve their
reading and math skills, brain function normalizes.
Rehabilitation Science.--The National Center for Medical
Rehabilitation Research (NCMRR) currently resides within NICHD, yet
there is a strong need for elevating the stature of NCMRR. We recommend
moving the NCMRR to an independent Institute or Center reporting
directly to the NIH Director, or to establish a new Office of
Rehabilitation Research within the Office of the NIH Director.
Implementation of this structural recommendation would require a
statutory change. Elevation of NCMRR has been viewed from the start as
a critical step in achieving sufficient critical mass to coordinate
rehabilitation science across all the Independent Centers at NIH that
conduct and support research directly addressing or related to
rehabilitation science.
These research efforts have made significant contributions to the
well-being of all Americans, but there is still much to discover. We
support the NICHD's recently released Scientific Vision and urge you to
support NICHD at funding levels that meet current needs for addressing
health issues across the lifespan. Thank you for your consideration and
we look forward to working with you on these critical issues.
______
Prepared Statement of the Friends of the National Institute of Dental
and Craniofacial Research
Mr. Chairman, Ranking Member, and distinguished Members of the
Subcommittee, the members of the Friends of the National Institute of
Dental and Craniofacial Research (FNIDCR), a leading broad-based
consortium of individuals, academic institutions, patient advocate
groups, dental societies, and corporations, that understands the
importance of dental, oral and craniofacial health to our society, are
requesting fiscal year 2015 funding under section 301 and Title IV of
the Public Health Service Act for the National Institute of Dental and
Craniofacial Research (NIDCR) to be appropriated at a recommended level
of 1.33 percent of the National Institutes of Health's (NIH's) total
fiscal year 2015 funding level.
The fiscal year 2014 level enacted by the omnibus bill is $398.65
million for NIDCR. After transfers, NIDCR's total amount for obligation
in fiscal year 2014 is $397.10 million. President Barack Obama's fiscal
year 2015 budget proposal for NIDCR, $397.13, is at best stagnate if
compared to total obligations, and at worse, a decrease of $1,519,000
if compared to the level Congress appropriated in the fiscal year 2014
omnibus bill. The end result is ongoing diminished grant opportunities
that will only discourage young and talented researchers. Also,
stagnated funding means NIDCR will not be able to keep up with the
increasing rate of medical inflation.
Background
From 1998 to 2011, NIDCR's percentage of total NIH funding
decreased from 1.53 percent to 1.33 percent, its lowest percentage,
amid a period when NIH's budget doubled. Save for a slight bump in
2012, this percentage remains at 1.33 percent. The Friends of NIDCR has
been working to reverse this troublesome trend--and return NIDCR
research to a percentage of total NIH funding that is more appropriate
and proper. For fiscal year 2014, NIDCR's percentage of total NIH
funding is 1.33 percent.
--If Congress enacts the president's fiscal year 2015 budget figures
for NIH and NIDCR, then NIDCR's percentage of total NIH funding
would be at an all-time low, 1.31 percent.
The Friends of NIDCR would welcome the opportunity to work with
members of this Subcommittee to ensure NIDCR funding realizes a
percentage of total NIH funding that is appropriate, yet realistic. The
research performed by NIDCR justifies this approach. This is why the
Friends of NIDCR recommends a modest increase in NIDCR's percentage of
total NIH funding for fiscal year 2015 of 1.33 percent based upon the
president's fiscal year 2015 budget request. This is also a consistent
recommendation based upon the level enacted by Congress for fiscal year
2014.
NIDCR: A Renown Leader in Research
For 66 years, NIDCR has been the leading sponsor of research and
research training in biomedical and behavioral sciences. Its mission is
to ``improve oral, dental and craniofacial health through research,
research training, and the dissemination of health information.''
NIDCR meets its mission by:
--Performing and supporting basic and clinical research;
--Conducting and funding research training and career development
programs to ensure an adequate number of talented, well-
prepared and diverse investigators is sustained;
--Coordinating and assisting relevant research and research-related
activities among all sectors of the research community; and
--Promoting the timely transfer of knowledge gained from research and
its implications for health to the public, health
professionals, researchers, and policy-makers.
In addition, NIDCR's Gold Standard Peer Review System ensures that
taxpayers' dollars are being utilized in a wise, effective and
productive manner.
NIDCR Research Benefits All Americans
Proper Federal funding of NIDCR will transform the future of
medical and dental practice to the benefit of our society and ease the
burden on our Nation's healthcare system. Examples of where NIDCR
research has and will benefit society are:
Tooth Decay: Fluorides and sealants have cut the rate of the number
of American adults, aged 45 and older, who are without teeth by more
than half since the 1950s. Government investment in oral health
research saved Americans $3 for every $1 invested.
Oral Cancer Detection: Oral cancer affects 38,000 Americans each
year and approximately 22 Americans die each day from it. Survival
rates are among the lowest of all the major cancers. It is difficult to
detect and hard to predict its outcome. However, if detected in early
stages, the 5-year survival rate is 83 percent. NIDCR-supported
research has yielded initial success with developing new diagnostic
techniques that can lead to early detection and life-saving
interventions. For example, oral cancer is the first cancer to have its
biomarkers mapped using Salivary Diagnostics and the presence of these
biomarkers resulted in an early diagnosis of oral cancer 93 percent of
the time. Furthermore, as a testament to scientific discoveries, oral
researchers have confirmed that oral cancer (traditionally thought of
as being driven by extensive use of tobacco and alcohol) possesses a
strong and growing link to Human Papilloma Virus (HPV). HPV is now the
cause of more oral cancers than smoking. NIDCR supports research aimed
to gain a clearer take on HPV-related oral cancers, including their
incidence, risk factors, natural history and biology.
Craniofacial Biology. Scientists are defining the genetics that
underlie the formation of the head and skull, and researchers are
identifying the key areas for craniofacial malformations. For example,
NIDCR-supported research has detected proteins associated with
craniosynostosis, which is the premature fusion of a baby's skull bones
that causes asymmetric skull growth. NIDCR believes this research could
provide the foundation for the development of early detection methods
and more effective treatments.
Genome-wide Association Studies. NIDCR supports the first genome-
wide association studies (``GWAS'') of cleft lip and/or palate and
dental caries. The studies offer significant potential for
understanding the molecular and genetic basis of cleft lip and/or
palate and dental caries with the goal of improving the ability to
predict and manage them by providing the first comprehensive
compilation of the biological instructions required to construct the
middle region of the human face and to define the genetics that create
its developmental disorders, according to NIDCR. The dental caries GWAS
revealed areas of the genome that make an individual more likely to
develop decay. Moreover, NIDCR researchers have identified six areas of
the genome that may put a person at risk for moderate or severe
periodontal disease and patients afflicted with Sjogren's Syndrome and
TMJD can benefit from this program.
Moreover, NIDCR research benefits millions of Americans with:
--Periodontal Disease,
--Chronic Dry Mouth,
--Chronic Facial and Oral Pain, such as TMJD, and
--Bone and Cartilage Regeneration.
How NIDCR Research Makes a Difference
Because Friends of NIDCR is a broad-based coalition of members, we
are able to share first-hand perspectives from across the spectrum of
the oral health community.
The TMJ Association:
During the past decade, NIDCR-funded research directed toward
Temporomandibular Disorders has been a ``game changer.'' Previously
thought to be a condition about teeth and jaws, research has
demonstrated that this is a complex condition mediated by genes, sex,
age, and epigenetics. We now also know that for many, TMD is a chronic
pain condition and that in addition these patients also present with
other comorbid pain conditions that co-occur more than by chance. These
findings have truly revolutionized the way that these conditions are
researched and will ultimately be treated. It is important to note that
the National Institutes of Health are the only sources of funding of TM
Disorders in the United States. We rely on their resources to improve
the healthcare and quality of life for the 35 million TMJ patients in
this country. Our hope is in science and the NIH, through its
Institutes such as NIDCR, provides us with that hope.
Ostrow School of Dentistry of the University of Southern
California:
NIDCR funding is essential to the success of several areas of
research at USC that directly impact millions of people in the U.S. and
worldwide. First, thanks to the NIDCR, we have made progress in
understanding cleft lip and palate, craniosynostosis, and other birth
defects of the craniofacial region. According to the CDC, the lifetime
cost of treating the children born each year in the U.S. with cleft lip
or palate is $697 million. Every day, our researchers come closer to
better treatments and preventive measures to help reduce this cost and
improve quality of life. Moreover, we are working to leverage the
dramatic potential of stem cells to regenerate bone and other tissues
that may be lost due to birth defects, trauma, or disease. The NIDCR
also funds our efforts to prevent dental caries, which is a major
global health concern affecting 92 percent of American adults. Finally,
the NIDCR supports our community outreach program in California's
diverse population, through which we are investigating how to improve
oral health for everyone in America.
Research Drives the Economy, Innovates
Despite the fact 54 percent of Americans thought Federal spending
for medical and health research should be exempt from across-the-board
cuts outlined in the Budget Control Act of 2011 \1\, the ramifications
of sequestration still linger. However, Friends of NIDCR maintains that
investment in medical research powers our innovation economy and
provides life-saving treatments and cures. For example, a typical NIH
grant supports the salaries of about seven high-tech jobs. Moreover,
cuts or stagnate funding will only set the U.S. back at a time when
other countries are rapidly increasing investment in research. Eighty-
five percent of likely voters are concerned about the impact of a
decreased Federal investment in research, including the possibility of
scientists leaving their profession or moving abroad to countries with
a stronger investment in research.\2\ NIDCR-funded grants contribute to
our Nation's economy and keep scientists from looking abroad for work.
fiscal year 2013 NIDCR-funded grants had a presence in 120
congressional districts (often multiple awards for a congressional
district) in 43 States and territories. This equates to 75 percent of
NIDCR-funded research being distributed to grantees at universities,
dental schools, and medical schools, primarily in the U.S. Therefore, a
significant portion of NIDCR-funded research occurs away from the NIH
campus. However, this nationwide NIDCR presence will surely decline
with decreased investment in research.
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\1\ ``More than Half of Americans Doubt U.S. Global Leadership in
2020,'' Research!America press release, March 14, 2012, http://
www.researchamerica.org/release --14march12--poll.
\2\ 2 Ibid.
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Health Disparities Research Program
Finally, through the NIDCR Health Disparities Research Program, a
difference is being made in meeting the health needs of our Nation's
low-income, underserved, and high-risk populations. Sadly, this need
was made apparent with the tragic passing of 12-year-old Deamonte
Driver who died from a tooth infection in 2007. As a result of the
program, tailored interventions to prevent dental caries and oral
cancer are being tested in community settings such as urban public
housing, community health centers, rural Project Head Start centers,
low-income senior housing facilities, and primary medical care offices.
recommendation
Eighty-five percent of Americans are concerned about stagnate
funding for medical research.\3\ Proper funding of medical and health
research is essential to the overall health and well-being of our
fellow Americans. We firmly contend that medical discoveries and
advances from NIDCR funding lead to improvements in dental practices
and change the scope of public health policies across the Nation.
Whether it is detecting a clear link between bacteria in the mouth and
heart disease--or discovering early stages of oral cancer--or searching
for breakthroughs to help combat facial and oral pain--we all benefit
when we make NIDCR a priority. Therefore, based upon the merits of the
research conducted by NIDCR, and its demonstrated benefits to the lives
of countless Americans, we respectfully request the Subcommittee to
fund NIDCR at 1.33 percent of NIH's funding level, so that it can
realize the full potential of its worthy mission and sustain its
beneficial scientific research.
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\3\ ``America Speaks,'' Poll Data Summary Volume 13,
Research!America, http://www.researchamerica.org/uploads/
AmericaSpeaksV13.pdf.
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Thank you for the opportunity to present our written testimony
before the Subcommittee.
[This statement was submitted by Christian Stohler, D.D.S.,
DrMedDent, President, Friends of the National Institute of Dental and
Craniofacial Research.]
______
Prepared Statement of the Friends of the National Institute on Drug
Abuse
Mr. Chairman and Members of the Subcommittee, thank you for the
opportunity to submit testimony to the Subcommittee in support of the
National Institute on Drug Abuse (NIDA). The Friends of the National
Institute on Drug Abuse is a coalition of over 150 scientific and
professional societies, patient groups, and other organizations
committed to preventing and treating substance use disorders as well as
understanding their causes through the research agenda of the National
Institute on Drug Abuse (NIDA).
We are pleased to provide testimony in support of the work carried
out by scholars around the country whose work is supported by NIDA.
Recognizing that so many health research issues are inter-related, we
request that the subcommittee provide at least $32 billion for the
National Institutes of Health (NIH) and within that amount a
proportionate increase for the National Institute on Drug Abuse, in
your Fiscal 2015 Labor, Health and Human Services, Education and
Related Agencies Appropriations bill. We also respectfully request the
inclusion of the following NIDA specific report language.
Marijuana Research. Efforts to legalize or ``medicalize'' marijuana
continue across the United States. The Committee understands that
research from different areas of science is converging on the fact that
regular marijuana use by young people can have a long-lasting negative
impact on the structure and function of their brains, resulting in
lower educational achievement, reduced IQ, etc. Research clearly
demonstrates that marijuana has the potential to cause problems in
daily life or make a person's existing problems worse. NIDA is
encouraged to continue to fund research on preventing and treating
marijuana abuse and addiction, and the possible health and policy
implications of proposals to implement ``medical marijuana'' or
marijuana legalization programs across the U.S.
Opiate Abuse and Addiction. The Committee is concerned about the
continued crisis of prescription drug abuse in the U.S. In particular,
the June 2011 IOM report on pain indicates that abuse and misuse of
prescription opioid drugs resulted in an annual estimated cost to the
nation of $72,500,000,000. Further, the Committee is very concerned
with the potential rise in heroin abuse and addiction as a result of
successful efforts to combat the prescription drug side of this issue.
The Committee urges NIDA to 1) continue funding research on medications
to alleviate pain, including the development of pain medications with
reduced abuse liability; 2) as appropriate, work with private companies
to fund innovative research into such medications; and 3) report on
what we know regarding the transition from opiate analgesics to heroin
abuse and addiction within affected populations.
Medications Development. The Committee recognizes that next-
generation pharmaceuticals will surely take advantage of new
technologies. In the context of NIDA funding, chief among these are
NIDA's current approaches to develop viable immunotherapeutic or
biologic (e.g., bioengineered enzymes) approaches for treating
addiction. The goal of this active area of research is the development
of safe and effective vaccines or antibodies that target specific
drugs, like nicotine, cocaine, and heroin, or drug combinations. The
Committee is excited by this approach--if successful, immunotherapies,
alone or in combination with other medications, behavioral treatments,
or enzymatic approaches, stand to revolutionize how we treat, and,
maybe even someday, prevent addiction. The Committee looks forward to
hearing more about work in this area.
Nurturing Talent and Innovation in Research. The Committee commends
NIDA for its continued support of innovative research on drug addiction
and related health problems such as pain and HIV/AIDS, and the
Institute's effort to be at the forefront of training the next
generation of innovative researchers. The 6 year-old Avant-Garde award
is a good example of a program that stimulates high-impact research
that could lead to groundbreaking opportunities for the prevention and
treatment of HIV/AIDS in drug abusers. The Committee understands that
NIDA is now crafting a new kind of award, which would blend NIH's
Pioneer and New Innovator award mechanisms. This new opportunity,
called ``AVENIR'' awards, is designed to attract creative young
investigators into HIV/drug abuse public health research. The Committee
strongly supports this effort, and asks the Institute to report on its
progress in future appropriations and related requests.
Research to Assist Military Personnel, Veterans, and Their
Families. The Committee recognizes the significant health challenges,
including substance abuse and addiction, faced by military personnel,
veterans, and their families. Many of these individuals need help
confronting war-related problems including traumatic brain injury,
PTSD, depression, anxiety, sleep disturbances, and substance abuse and
addiction. The Committee commends NIDA for its successful efforts to
coordinate and support research with the Department of Veterans
Affairs, Department of Defense, and other NIH Institutes focusing on
these populations, and strongly urges NIDA to continue work in this
area.
Raising Awareness and Engaging the Medical Community in Drug Abuse
and Addiction Prevention and Treatment. The Committee is very pleased
with NIDAMed, an initiative designed to reach out to physicians,
physicians in training, and other healthcare professionals. The
Committee urges the Institute to continue its focus on activities to
provide physicians and other medical professionals with the tools and
skills needed to incorporate drug abuse screening and treatment into
their clinical practices.
Drug abuse is costly to Americans; it ruins lives, while tearing at
the fabric of our society and taking a huge financial toll on our
resources. Beyond the unacceptably high rates of morbidity and
mortality, drug abuse is often implicated in family disintegration,
loss of employment, failure in school, domestic violence, child abuse,
and other crimes. Placing dollar figures on the problem; smoking,
alcohol and illegal drug use results in an exorbitant economic cost on
our nation, estimated at over $600 billion annually. We know that many
of these problems can be prevented entirely, and that the longer we can
delay initiation of any use, the more successfully we mitigate future
morbidity, mortality and economic burdens.
Over the past three decades, NIDA-supported research has
revolutionized our understanding of addiction as a chronic, often-
relapsing brain disease --this new knowledge has helped to correctly
situate drug addiction as a serious public health issue that demands
strategic solutions. By supporting research that reveals how drugs
affect the brain and behavior and how multiple factors influence drug
abuse and its consequences, scholars supported by NIDA continue to
advance effective strategies to prevent people from ever using drugs
and to treat them when they cannot stop.
NIDA supports a comprehensive research portfolio that spans the
continuum of basic neuroscience, behavior and genetics research through
medications development and applied health services research and
epidemiology. While supporting research on the positive effects of
evidence-based prevention and treatment approaches, NIDA also
recognizes the need to keep pace with emerging problems. We have seen
encouraging trends--significant declines in a wide array of youth drug
use--over the past several years that we think are due, at least in
part, to NIDA's public education and awareness efforts. However, areas
of significant concern include the recent increase in lethalities due
to heroine, as well as the continued abuse of prescription opioids and
the recent increase in designer drugs availability and their
deleterious effects. The need to increase our knowledge about the
effects of marijuana is most important now that decisions are being
made about its approval for medical use and/or its legalization. We
support NIDA in its efforts to find successful approaches to these
difficult problems.
The Nation's previous investment in scientific research to further
understand the effects of abused drugs on the body has increased our
ability to prevent and treat addiction. As with other diseases, much
more needs be done to improve prevention and treatment of these
dangerous and costly diseases. Our knowledge of how drugs work in the
brain, their health consequences, how to treat people already addicted,
and what constitutes effective prevention strategies has increased
dramatically due to support of this research. However, since the number
of individuals continuing to be affected is still rising, we need to
continue the work until this disease is both prevented and eliminated
from society.
We understand that the fiscal year 2015 budget cycle will involve
setting priorities and accepting compromise, however, in the current
climate we believe a focus on substance abuse and addiction, which
according to the World Health Organization account for nearly 20
percent of disabilities among 15-44 year olds, deserves to be
prioritized accordingly. We look forward to working with you to make
this a reality. Thank you for your support for the National Institute
on Drug Abuse.
______
Prepared Statement of the FSH Society, Inc.
Honorable Chairwoman Mikulski and Ranking Member Harkin, thank you
for the opportunity to submit this testimony. Facioscapulohumeral
muscular dystrophy (FSHD), is one of the most common adult muscular
dystrophies with a prevalence of 1:15,000--1:20,000.\1 2\ For a half-
million men, women, and children worldwide the major consequence of
inheriting this genetic form of muscular dystrophy is a lifelong
progressive loss of all skeletal muscles. FSHD is a crippling and life
shortening disease. No one is immune. It is both genetically and
spontaneously transmitted to children. It can affect multiple
generations and entire families.
---------------------------------------------------------------------------
\1\ Flanigan KM, et al. Genetic characterization of a large,
historically significant Utah kindred with facioscapulohumeral
dystrophy. Neuromuscul Disorders 2001;11:525--529.
\2\ Mostacciuolo ML, et al. Facioscapulohumeral muscular dystrophy:
epidemiologicaland molecular study in a north-east Italian population
sample. Clinical Genetics 2009;75:550--555.
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With FSHD there is a loss of muscle strength that ranges between
one and 4 percent a year during a lifetime. In terms of functional
impairment, 20 percent of FSHD-affected individuals over age fifty will
require the use of a wheelchair. FSHD also has very specific non-
muscular manifestations; hearing-loss, restrictive lung disease,
supraventricular arrhythmias (rare), and retinal vasculopathy. 95
percent of individuals with FSHD have the FSHD1 (FSHD1A OMIM: 158900)
genetic variation--caused by the contraction of DNA macrosatellite
repeat units, termed D4Z4 repeats, on chromosome 4, leading to the
release of transcriptional repression of a retrogene (DUX4) believed to
be associated with the cause of disease. Of the 5 percent of FSHD
individuals remaining, 80 percent of those are the FSHD2 (FSHD1B OMIM:
158901) genetic variation--caused by mutations in the SMCHD1 gene on
chromosome 18 that helps to maintain the structure of the D4Z4 repeats
on the long arm of chromosome 4.
The National Institutes of Health (NIH) is the principal source of
funding of research on FSHD currently at the $5 million level. For
nearly two decades, this Committee has supported the incremental growth
in funding for FSHD research. I am pleased to report that this modest
investment has produced huge scientific returns.
1. Congress has made a major difference in muscular dystrophy. I
have testified many times before Congress, nearly fifty. When I first
testified, we did not know the mechanism of this disease. Now we do.
When I first testified, we assumed that FSHD was a rare form of
muscular dystrophy. Now we understand it to be one of the most
prevalent forms of muscle disease, if not the most prevalent muscle
disease based on new ways of evaluating the disease clinically within
families. Congress is responsible for this success, through its
sustaining support of the NIH and the enactment of the Muscular
Dystrophy CARE Act. We are aware that MD Care Act does not set the
amount of spending on FSHD or the other dystrophies at the NIH and we
recognize that funding levels are determined in the appropriations
process and the numbers of grant applications received and funded by
the NIH on FSHD. Even though it is a technically separate legislative
process, the reauthorization of the MD Care Act does raise the
visibility of all the muscular dystrophies which can be of help in the
appropriations process--and we thank you for your support of the MD
Care Act. Further, we recognize and feel at this time in FSHD research
that there are additional efforts and pathways that Congress can
request and the NIH can enact to increase the amount of research
funding on FSHD in the NIH portfolio that neither increases the NIH
budget required nor takes money from another area of research.
2. Quantum leaps in our understanding of FSHD have occurred in past
three and a half years. The past three and a half years have seen
remarkable contributions made by researchers funded by NIH.
--On August 19, 2010, American and Dutch researchers published a
paper which dramatically expanded our understanding of the
mechanism of FSHD.\3\ A front page story in the New York Times
quoted the NIH Director Dr. Francis Collins saying, ``If we
were thinking of a collection of the genome's greatest hits,
this would go on the list.'' \4\
---------------------------------------------------------------------------
\3\ Lemmers, RJ, et al, A Unifying Genetic Model for
Facioscapulohumeral Muscular Dystrophy Science 24 September 2010: Vol.
329 no. 5999 pp. 1650-1653.
\4\ Kolata, G., Reanimated `Junk' DNA Is Found to Cause Disease.
New York Times, Science. Published online: August 19, 2010 http://
www.nytimes.com/2010/08/20/science/20gene.html.
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--Two months later, another paper was published that made a second
critical advance in determining the cause of FSHD.\5\ The
research shows that FSHD is caused by the inefficient
suppression of a gene that may be normally expressed only in
early development.
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\5\ Snider, L., Geng, L.N., Lemmers, R.J., Kyba, M., Ware, C.B.,
Nelson, A.M., Tawil, R., Filippova, G.N., van der Maarel, S.M.,
Tapscott, S.J., and Miller, D.G. (2010). Facioscapulohumeral dystrophy:
incomplete suppression of a retrotransposed gene. PLoS Genet. 6,
e1001181.
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--On January 17, 2012, an international team of researchers based out
of Seattle discovered a stabilized form of a normally
suppressed gene called DUX4 required to develop chromosome 4
linked FSHD.\6\
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\6\ Geng et al., DUX4 Activates Germline Genes, Retroelements, and
Immune Mediators: Implications for Facioscapulohumeral Dystrophy,
Developmental Cell (2012), doi:10.1016/j.devcel.2011.11.013.
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--Six months later, another high profile paper produced by a Senator
Paul A. Wellstone Cooperative Research Center of the NIH, used
sufficiently ``powered'' large collections of genetically
matched FSHD cell lines generated by the NIH center that are
both unique in scope and shared with all researchers worldwide,
to improve on the Seattle group's finding by postulating that
DUX4-fl expression is necessary but not sufficient by itself
for FSHD muscle pathology.\7\ This work was also supported by a
NIH cooperative research center grant mandated by MD CARE Act.
---------------------------------------------------------------------------
\7\ Jones TI, et al, Facioscapulohumeral muscular dystrophy family
studies of DUX4 expression: evidence for disease modifiers and a
quantitative model of pathogenesis. Hum Mol Genet. 2012 Oct
15;21(20):4419-30. Epub 2012 Jul 13.
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--On July 13, 2012, a team of researchers from the, United States,
Netherlands and France identified mutations in a gene causing
80 percent of another form of FSHD. This paper furthers our
understanding of the molecular pathophysiology of FSHD. This
work too was supported in part by a program project grant from
NIH.\8\
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\8\ Lemmers, RJ, et al, Digenic inheritance of an SMCHD1 mutation
and an FSHD-permissive D4Z4 allele causes facioscapulohumeral muscular
dystrophy type 2. Nat Genet. 2012 Dec;44(12):1370-4. doi: 10.1038/
ng.2454. Epub 2012 Nov 11.
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--In 2013 and continuing into 2014, papers have been published
clearly documenting functional impairment in FSHD, clinical and
genetic features of hearing loss FSHD, restrictive lung disease
and respiratory insufficiency, Coats syndrome and vision loss
in FSHD, high-throughput screening that identify inhibitors of
DUX4-induced myoblast toxicity, better definition of epigenetic
features of FSHD, Pain and FSHD, MRI/MRS studies, biomarkers
for FSHD, the demonstration that although the transcription of
the toxic protein DUX4 occurs in only a limited number of
nuclei, the resulting protein diffuses into nearby nuclei
within the myotubes, thus spreading aberrant gene expression
throughout a muscle, to name a few.
Many of these researchers have started their efforts in FSHD with
seed funding from the FSH Society and have received continued support
from the FSH Society, the NIH, and the Muscular Dystrophy Association
and other partners.
3. Remarkable progress in FSHD research and the need to keep moving
forward. Last October, nearly 100 researchers from around the world
gathered under the direction of Massachusetts Institute of Technology
professor, David Housman, PhD, Chair of the FSH Society's Scientific
Advisory Board, at the David H. Koch Center for Integrative Cancer
Research on the campus of M.I.T. for the annual FSH Society
International Research Consortium meeting; there was a palpable feeling
of FSHD research having ``arrived'' in the big time. The general
discussion of day two covered four major areas. With respect to the
first area, called DUX4, the unanimous conclusion of the general
discussion was that over-expression of the toxic transcription factor
DUX4 is at the root of FSHD1 and FSHD2 and that DUX4 expression is
necessary but not always sufficient to cause FSHD. Research should
focus on upstream and downstream molecular pathways and mechanisms as
they form the most plausible intervention targets. The group also
discussed needs and priorities in three additional areas: disease
models, intervention, clinical studies and trial readiness. The
priorities stated for 2014, at the October 21-22, 2013, FSH Society
FSHD IRC meetings are as follows: \9\
---------------------------------------------------------------------------
\9\ 2013 FSH Society FSHD International Research Consortium, held
October 22-23, 2013 co-sponsored by DHHS NIH NICHD University of
Massachusetts School of Medicine Senator Paul D. Wellstone MD CRC for
FSHD. To read the expanded summary and recommendations of the group
see: http://www.fshsociety.org/pages/sciConsortium.html.
---------------------------------------------------------------------------
--The DUX4 interactome
--Understanding DUX4 manifestation and variation
--Additional genetic heterogeneity; non-FSHD1 and FSHD2
--Disease models
--Well documented natural history with reliable endpoints; modulating
mechanisms/genes
--Increasing data depth of patient databases with extensive (follow-
up) clinical data
--Prepare for clinical trials: reliable and meaningful outcome
measures; with access to discreet patient populations and
disease mechanism of action classes.
--Therapy; proof-of-principle experiments
--Focus on translational research; from clinic to bench and back
--Understanding pathophysiology of FSHD: connection to DUX4,
heterogeneity, asymmetry, role of inflammation; infiltrates and
etiology
Given the recent developments, there is a need to ramp up the
preclinical enterprise and build/organize infrastructure needed to
conduct clinical trials. Our immediate priorities should be to confirm
the new hypotheses and targets. We need to be prepared for this new era
in the science of FSHD. Many leading experts are now turning to work on
FSHD not only because it is one of the most complicated and challenging
problems seen in science, but because it represents the potential for
great discoveries, insights into stem cells, transcriptional processes,
new ways of thinking about disease of epigenetic etiology, and for
treating diseases.
4. NIH Funding for Muscular Dystrophy. Mr. Chairman, these major
advances in scientific understanding and epidemiological surveillance
are not free. They come at a cost. Since Congress passed the MD CARE
Act, research funding at NIH for muscular dystrophy has increased 4-
fold. While FSHD research funding has increased 12-fold during this
period, the level of funding is still anemic and, for FSHD, has been
astonishingly flat for the past 6 years.
[Dollars in millions]
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Fiscal Year
---------------------------------------------------------------------------------------------------------------------------------
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 e 2015 e
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
All MD........................................................ 39.1 38.7 39.5 39.9 47.2 56 83 86 75 75 76 78 78
FSHD.......................................................... 1.5 2.2 2.0 1.7 3 3 5 6 6 5 5 6 6
FSHD (percent total MD)....................................... 4 6 5 4 5 5 6 7 8 7 7 8 8
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
FSHD Research Dollars (in millions) and FSHD as a Percentage of Total NIH Muscular Dystrophy Funding.
Sources: NIH/OD Budget Office and NIH OCPL and NIH RCDC RePORT (e = estimate).
Despite the great success of the past three and a half years in the
science of FSHD brought about by Congress we are concerned that under
the current funding environment that new research projects will not be
funded or existing programs will not be renewed. We have conveyed to
the NIH leadership at the Office of the Director, NIAMS, NINDS, NICHD,
NHLBI and the Executive Secretary of the MDCC our grave concern that
FSHD research is way too under-represented in the NIH portfolio and
needs a proactive effort on the part of NIH.
Alan E. Guttmacher, MD., Director, NICHD and chair of the Muscular
Dystrophy Coordinating Committee (MDCC) recently wrote to me in
response to a letter I sent to NIH Director, Dr. Francis Collins asking
for a significant improvement in the overall level of funding for FSHD,
that though ``it is notable that NIH funding for all forms of muscular
dystrophy has nearly doubled since the 2006 NIH Action Plan on Muscular
Dystrophy was released. [and] Since this has been a period of
relatively flat funding for NIH, increased funding for anyone area
speaks to the excellent quality of the research applications received
during that time, and this is true of FSHD research applications where
funding has almost tripled. We believe that the 2006 Action Plan was
instrumental in improving coordination among the Institutes and Centers
at NIH that support research on the muscular dystrophies, so that
scarce resources are well-spent. We plan to revise the Action Plan this
year, with a meeting in July to discuss what research opportunities
have emerged; the goal is to ask the MDCC to approve the revised plan
at its Fall 2014 meeting.'' While we whole-heartedly agree with these
statements and we are instrumental and involved in the MD CARE Act and
most appreciative of all of NIH's efforts and Congress' work in this
area--we do not however agree on the plus one order of magnitude (x10)
of difference between muscular dystrophy funding and FSHD funding.
While all muscular dystrophy increased from $39.9 million to $78
million; FSHD increased from $1.7 million to $6 million. The economy of
scale is so different in particular for FSHD, being equally devastating
and burdensome as the disease receiving the most funding in this
category, and though it functions in the exact same U.S. Federal
research infrastructure. NIH needs to redress the imbalance of funding
in the muscular dystrophy portfolio by fostering opportunities for
multidisciplinary research on FSHD, a common and complex form of
dystrophy, commensurate with its prevalence and disease burden. The
future action plan should address this issue head-on.
We request for fiscal year 2015, a tripling of the NIH FSHD
research portfolio to $18 million or a level of approximately 20
percent of the total muscular dystrophy funding at NIH. This will allow
an expansion of basic research awards, expansion of post-doctoral and
clinical training fellowships, dedicated centers to design and conduct
clinical trials on FSHD and more U.S. DHHS NIH Senator Paul D.
Wellstone Muscular Dystrophy Cooperative Research Centers.
Agency: National Institutes of Health (NIH)
Account: National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS), and the National Institute of Neurological
Disorders and Stroke (NINDS), and the Eunice Kennedy Shriver National,
Institute of Child Health and Human Development (NICHD)
Fiscal year 2015 Report Language: The Committee encourages the NIH
to foster opportunities for multidisciplinary research on
facioscapulohumeral muscular dystrophy (FSHD), a common and complex
form of muscular dystrophy, commensurate with its prevalence and
disease burden. The Committee hopes such advances will be utilized to
help advance treatments and access to therapies for this grave disease.
We are aware of the great pressures on the Federal budget, but NIH
can easily help increase its portfolio on FSHD given the breakneck
speed of discovery in FSHD. These are easy ways for NIH to convey to
researchers that it has a revised plan and an interest in funding
research in FSHD. There are no quotas on peer-reviewed research above
pay line at the NIH, and NIH can help by issuing written announcements
that efforts invested in writing FSHD grant applications will be met
with interest. This is the time to fully and expeditiously exploit the
advances for which the American taxpayer has paid. Thank you for this
opportunity to testify before your committee.
[This statement was submitted by Daniel Paul Perez, President &
CEO, FSH Society.]
______
Prepared Statement of the GBS/CIDP Foundation International
Chairman Harkin and distinguished members of the Subcommittee,
thank you for your time and your consideration of the priorities of the
community of individuals impacted by Guillain-Barre Syndrome (GBS),
Chronic Inflammatory Demyelinating Polyneuropathy (CIDP), and related
conditions as you work to craft the fiscal year 2015 Labor, Health and
Human Services Appropriations Bill.
about gbs and cidp
Guillain-Barre Syndrome
GBS is an inflammatory disorder of the peripheral nerves outside
the brain and spinal cord. It's also known as Acute Inflammatory
Demyelinating Polyneuropathy and Landry's Ascending Paralysis.
The cause of GBS is unknown. We do know that about 50 percent of
cases occur shortly after a microbial infection (viral or bacterial),
some as simple and common as the flu or food poisoning. Some theories
suggest an autoimmune trigger, in which the patient's defense system of
antibodies and white blood cells are called into action against the
body, damaging myelin (nerve covering or insulation), leading to
numbness and weakness.
GBS in its early stages is unpredictable, so except in very mild
cases, most newly diagnosed patients are hospitalized. Usually, a new
case of GBS is admitted to ICU (Intensive Care) to monitor breathing
and other body functions until the disease is stabilized. Plasma
exchange (a blood ``cleansing'' procedure) and high dose intravenous
immune globulins are often helpful to shorten the course of GBS. The
acute phase of GBS typically varies in length from a few days to
months, with over 90 percent of patients moving into the rehabilitative
phase within four weeks. Patient care involves the coordinated efforts
of a team such as a neurologist, physiatrist (rehabilitation
physician), internist, family physician, physical therapist,
occupational therapist, social worker, nurse, and psychologist or
psychiatrist. Some patients require speech therapy if speech muscles
have been affected.
Recovery may occur over 6 months to 2 years or longer. A
particularly frustrating consequence of GBS is long-term recurrences of
fatigue and/or exhaustion as well as abnormal sensations including pain
and muscle aches. These can be aggravated by `normal' activity and can
be alleviated by pacing activity and rest.
Chronic Inflammatory Demyelinating Polyneuropathy
CIDP is a rare disorder of the peripheral nerves characterized by
gradually increasing weakness of the legs and, to a lesser extent, the
arms.
It is the gradual onset as well as the chronic nature of CIDP that
differentiates it from GBS. Fortunately, CIDP is even rarer than GBS.
The incidence of new cases is estimated to be between 1.5 and 3.6 in a
million people (compare to GBS: 1-2 in 100,000).
Like GBS, CIDP is caused by damage to the covering of the nerves,
called myelin. It can start at any age and in both genders. Weakness
occurs over two or more months.
Unlike GBS, CIDP is not self-limiting (with an end to the acute
phase). Left untreated, 30 percent of CIDP patients will progress to
wheelchair dependence. Early recognition and treatment can avoid a
significant amount of disability.
Post-treatment life depends on whether the disease was caught early
enough to benefit from treatment options. Patients respond in various
ways. The gradual onset of CIDP can delay diagnosis by several months
or even years, resulting in significant nerve damage that may take
several courses of treatment before benefits are seen. The chronic
nature of CIDP differentiates long-term care from GBS patients.
Adjustments inside the home may need to be made to facilitate a return
to normal life.
about the foundation
The Foundation's vision is that every person afflicted with GBS,
CIDP, or variants has convenient access to early and accurate
diagnosis, appropriate and affordable treatments, and dependable
support services.
The Foundation's mission is to improve the quality of life for
individuals and families across America affected by GBS, CIDP, and
their variants by:
--Providing a network for all patients, their caregivers and families
so that GBS or CIDP patients can depend on the Foundation for
support, and reliable up-to-date information.
--Providing public and professional educational programs worldwide
designed to heighten awareness and improve the understanding
and treatment of GBS, CIDP and variants.
--Expanding the Foundation's role in sponsoring research and engaging
in patient advocacy.
sequestration
We have heard from the medical research community that
sequestration and deficit reduction activities have created serious
issues for Federal funding opportunities and the career development
pipeline. In order to ensure that research into GBS, CIDP, and related
disorders can continue to move forward, and, more importantly, to
ensure that our country is adequately preparing the next generation of
young investigators, we urge you to avert, mitigate, or otherwise
eliminate the specter of sequestration. While the Foundation has
anecdotal accounts of the harms of sequestration, the Federated
American Societies for Experimental Biology has reported:
--In constant dollars (adjusted for inflation), the NIH budget in
fiscal year 2013 was $6 billion (22.4 percent) less than it was
in fiscal year 2003.
--The number of competing research project grants (RPGs) awarded by
NIH has also fallen sharply since fiscal year 2003. In fiscal
year 2013, NIH made 8,283 RPG awards, which is 2,110 (20.3
percent) fewer than in fiscal year 2003.
--Awards for R01-equivalent grants, the primary mechanism for
supporting investigator-initiated research, suffered even
greater losses. The number awarded fell by 2,528 (34 percent)
between fiscal year 2003 and fiscal year 2013.
The pay line for some NIH funding mechanisms has fallen from 18
percent to 10 percent while the average age for a researcher to receive
their first NIH-funded grant has climbed to 42. These are strong
disincentives to choosing a career as a medical researcher. Our
scaling-back is occurring at a time when many foreign countries are
investing heavily in their biotechnology sectors. China alone plans to
dedicate $300 million to medical research over the next 5 years; this
amount is double the current NIH budget over the same period of time.
Scientific breakthroughs will continue, but America may not benefit
from the return-on-investment of a robust biotechnology sector. For the
purposes of economic and national security, as well as public health,
the Foundation asks that you work with your colleagues to eliminate
sequestration and recommit to supporting this Nation's biomedical
research enterprise.
centers for disease control and prevention
CIDP is a progressive condition with serious health impacts.
Patients can end up almost completely paralyzed and on a ventilator.
The key to limiting serious health impacts is an early and accurate
diagnosis. The time it takes for a CIDP patient to begin therapy is
linked to the length of therapy and the seriousness of the health
impacts. An early diagnosis can mean the difference between a 3 month
or 18 month hospital stay, or no hospitalization at all. For the
Federal healthcare system, there is an economic incentive to ensure
early and accurate diagnosis as longer hospitalizations equate to
higher costs.
CDC and NCCDPHP have resources that could be brought to bear to
improve public awareness and recognition of CIDP and related
conditions. In order to initiate new, potentially cost-saving programs,
CDC requires meaningful funding increases to support crucial
activities.
national institutes of health
NIH hosts a modest research portfolio focused on GBS, CIDP, and
related conditions. This research has led to important scientific
breakthroughs and is well positioned to vastly improve our
understanding of the mechanism behind these conditions. In fact, NINDS,
NIAID, and the Office of Rare Diseases Research (ORDR) housed within
NCATS have expressed interest in hosting a State-of-the-Science
Conference on autoimmune peripheral neuropathies. This conference would
allow intramural and extramural researchers to develop a roadmap that
would lead research into these conditions into the next decade. While
such a conference would not require additional appropriations, the
Foundation urges you to provide NIH with meaningful funding increases
to facilitate growth in the GBS, CIDP, and related conditions research
portfolio.
Thank you for your time and your consideration of the community's
requests.
______
Prepared Statement of Girl Scouts of the USA
As the preeminent leadership development organization for girls,
Girl Scouts of the USA (Girl Scouts) serves over two million girls each
year, ages 5 to 17, from every corner of the United States and its
territories, with value placed on diversity and inclusiveness. We also
serve nearly 17,000 American girls living outside of the United States
in over 90 countries. Through our 112 councils and USA Girl Scouts
Overseas, and more than 800,000 dedicated volunteers, we continue to
deliver the Girl Scout Leadership Experience (GSLE)--the world's most
comprehensive and best program for girls' leadership development.
building girls leadership
Girl Scout experiences through GSLE are, as much as possible, girl-
led and encourage hands-on and cooperative learning. Our framework
specifies 15 outcomes--behaviors, attitudes, skills and values--that
develop girls of courage, confidence and character. We provide
significant financial assistance to vulnerable girls who cannot afford
to pay to belong to Girl Scouts. In many communities, Girl Scouts is
the single most visible and viable positive choice for these girls as
opposed to negative behavior. Girl Scouts plays a major role in helping
girls find their voice in a positive and productive way.
Women today are well educated but still underrepresented in high-
paying positions and positions of leadership, facing societal barriers
to leading and achieving success in everything from technology and
science to business and industry. With this in mind, we need a bold
policy shift so that girls are able to achieve their full leadership
potential now and later in life, as women. Girl Scouts is eager to work
with policymakers to create opportunities and environments that foster
girls' leadership development.
pension relief
Under Department of Labor, General Provisions, Girl Scouts
respectfully requests the insertion of the following language as our
highest priority request:
Sec.--Election Not To Be Treated as an Eligible Charity Plan.--A
plan sponsor of an eligible charity plan (as defined in subsection (d)
of section 104 of the Pension Protection Act of 2006) may elect,
effective for the first plan year beginning after December 31, 2013, to
have section 104 of such Act not apply to such plan. In the case of
such an election, solely for plan years beginning after December 31,
2013, section 430(c) of the Internal Revenue Code of 1986 and section
303(c) of the Employee Retirement Income Security Act of 1974 shall
apply as if such sections had applied to the first two plan years
beginning after December 31, 2009, and as if the plan sponsor had
elected to apply section 430(c)(2)(D)(iii) of such Code and section
303(c)(2)(D)(iii) of such Act with respect to those two plan years.
The proposed language, which would only affected eligible charities
and thus should not have an associated cost, would modify the rule
established by section 202(b) of the Preservation of Access to Care for
Medicare Beneficiaries and Pension Relief Act of 2010, Public Law 111-
192. The effect of the proposed language is similar in effect to
section 2 of H.R. 4915, as passed by the Senate in December of 2010,
which also allowed a plan sponsor of an eligible charity plan not to
have section 104 of the Pension Protection Act of 2006 apply.
Girl Scouts organization, on behalf of the millions of girls we
serve, respectfully requests this technical fix. The language simply
says that as of 2014, we, and all similarly structured charities, be
permitted to elect in to the Pension Protection Act funding rules,
which are the Federal pension rules applicable to corporate America.
In addition to our request pertaining to pension relief, the following
are the key policy priority areas where we can offer research
and programmatic success stories:
stem education
As the preeminent organization for girls and a leader on informal
STEM education, Girl Scouts is committed to ensuring that every girl
has the opportunity to explore and build an interest in science,
technology, engineering and mathematics. The strength of our Nation
depends on increasing girls' involvement in STEM, to develop critical
thinking, problem solving and collaboration skills that are important
throughout life.
In 2012, the Girl Scout Research Institute released Generation
STEM: What Girls Say about Science, Technology, Engineering and Math,
which found girls are interested in STEM and aspire to STEM careers,
but need further exposure and education about what STEM careers can
offer and how STEM can help girls make a difference in the world.
Among some of Generation STEM's other findings:
--74 percent of teen girls are interested in the field of STEM and
STEM subjects. Girls like the process of learning, asking
questions, and problem solving.
--Girls who are interested in STEM are significantly better students,
have higher confidence in their abilities, and higher academic
goals.
--But while 81 percent say they are interested in pursuing STEM
careers, only 13 percent say it's their first choice. About
half of all girls feel that STEM isn't a typical career path
for girls. 57 percent of girls say that if they went into a
STEM career, they'd have to work harder than a man just to be
taken seriously.
--African American and Hispanic girls have high interest in STEM,
high confidence and work ethic, but say they have fewer
supports and less STEM exposure than Caucasian girls.
Research shows that girl-only settings not only provide a sense of
belonging, but are more effective environments for personal
development, including learning new skills and building self-
confidence. In emotionally and physically safe environments, like those
provided by Girl Scouts, girls partner with positive role models in a
range of activities not limited by gender stereotypes. Girl Scout
programs also emphasize partnerships, public education campaigns,
mentorship programs, career exploration, traditional badges, and
innovative new programming.
--As Congress considers consolidations and a redesign of existing
Federal STEM programs, we urge you to invest more of a focus on
engaging and motivating girls in STEM, in particular girls in
underrepresented minorities and at younger ages before their
interest wanes in middle school. Strategies include introducing
girls to diverse role models and mentors; promoting proven
techniques for engaging girls in STEM including, single-gender
learning; and, hands-on and experiential learning opportunities
in after-school or out-of-school environments.
financial literacy
The world's current economic challenges have made financial
literacy skills matter now more than ever. Girl Scouts offers a
financial literacy program at every grade level from K-12. Through our
Girl Scout financial education programming, girls learn to handle money
and the basics of budgeting, banking, saving, using credit and planning
for retirement and even practicing philanthropy.
Additionally, the Girl Scout Cookie Program is often girls' first
introduction to business planning and entrepreneurship. The $790
million Girl Scout Cookie Program is the largest girl-led business in
the country.
While lack of financial literacy is a growing concern, relatively
little research has been conducted on how girls think about and
experience money and finances. To address this gap, the Girl Scout
Research Institute recently conducted a study, Having It All: Girls and
Financial Literacy, with girls and their parents. It found girls need
and want financial literacy skills to help them achieve their dreams,
with 90 percent saying it is important for them to learn how to manage
money; however, just 12 percent of girls surveyed feel very confident
about making financial decisions.
--To be successful and sustainable, financial education must begin
early, continue throughout elementary and secondary education,
and be relevant. And although 93 percent of the public believes
all high school students should be required to take a class in
financial education, only four States have made a semester-long
course in financial literacy a graduation requirement.\1\ In
addition to providing teachers with training and materials, we
believe policy support for after-school and community-based
programs is critical if girls are to learn money-management
skills and have real-world financial literacy experiences that
will serve them throughout their lives.
---------------------------------------------------------------------------
\1\ Back to School Survey Shows Americans Want Personal Finance
Taught in the Classroom, Visa, July 20, 2010.
---------------------------------------------------------------------------
healthy living--bullying and relational aggression
As exemplified through our program experience and research, Girl
Scouts understands the complex issue of healthy living and what
motivates youth--especially girls--to adopt healthy lifestyles.
Improving youths' physical health and emotional well-being are not
mutually exclusive. Youth, especially girls, experience them in an
interrelated fashion. Girls place the same or even greater emphasis on
social and emotional health as physical health.
The Girl Scout Research Institute's original research report,
Feeling Safe: What Girls Say, found that nearly half (46 percent) of
girls define safety as not having their feelings hurt, and
approximately one-third of all girls worry about being teased, bullied,
threatened, or having their feelings hurt when spending time with
peers, participating in groups, and trying new things. Our report, The
New Normal? What Girls Say About Healthy Living, tells us that a girl's
relationships with her peers are critical components of her health and
safety.
Our BFF (Be a Friend First) curriculum is focused on middle-school
girls and designed to easily integrates into existing health or
character education classes, or can even serve as an after-school
program in the community.
--As the Department of Education has proposed a safe schools
initiative that includes a positive school climate focus, Girl
Scouts supports this kind of effort that embraces a holistic
definition of health that addresses both the physical health
and emotional wellness of youth. National youth serving
organizations such as Girl Scouts, should be seen as vital
partners for schools in developing relevant solutions such as
policies to address relational aggression and evaluating and
implementing programs that prevent relational aggression and
build healthy relationships.
closing
We look forward to being a partner with Congress as you make
difficult funding decisions in the areas of supporting healthy living,
improving financial education of our youth, and building a pipeline of
girls and underrepresented minorities in STEM careers. Thank you, and
please consider us a resource in these areas.
[This statement was submitted by Anna Maria Chavez, Girl Scouts of
the USA.]
______
Prepared Statement of Global Health Technologies Coalition
Chairman Harkin, Ranking Member Moran, and members of the
Committee, thank you for the opportunity to provide testimony on the
fiscal year 2015 appropriations funding for the National Institutes of
Health (NIH) and the Centers for Disease Control and Prevention (CDC).
We appreciate your leadership in promoting the importance of
international development, in particular global health. We hope that
your support will continue. I am submitting this testimony on behalf of
the Global Health Technologies Coalition (GHTC), a group of nearly 30
nonprofit organizations working together to promote policies that
advance research and development (R&D) of new global health
innovations--including new vaccines, drugs, diagnostics, microbicides,
and other tools--to combat global health diseases. The GHTC's members
strongly believe that to meet the global health needs of tomorrow, it
is critical to invest in research today so that the most effective
health solutions are available when we need them. My testimony reflects
the needs expressed by our member organizations which work with a wide
variety of partners to develop new and more effective life-saving
technologies for the world's most pressing health issues. We strongly
urge the Committee to continue its established support for global
health R&D by 1) sustaining and supporting U.S. investment in global
health research and product development and fully funding the NIH at a
level of at least $32 billion, and providing robust funding for the
CDC, with $464 million for the CDC Center for Global Health and $445
million for the CDC Center for Emerging Zoonotic and Infectious
Diseases (NCEZID), 2) requiring leaders at the NIH, CDC, the Food and
Drug Administration (FDA), and the Secretariat of the U.S. Department
of Health and Human Services to join leaders of other U.S. agencies to
develop a cross-U.S. government global health R&D strategy to ensure
that U.S. investments in global health research are efficient,
coordinated, and streamlined, and 3) removing the clinical trial phase
restriction from the legal language dictating the activities of the
National Center for Advancing Translational Sciences (NCATS).
Critical need for new global health tools
Our Nation's investments have made historic strides in promoting
better health around the world: nearly ten million people living with
HIV/AIDS now have access to life-saving medicines; new, cost-effective
tools help us diagnose diseases quicker and more efficiently than ever
before; and innovative new vaccines are making significant dents in
childhood mortality. While we must increase access to these and other
proven, existing health tools to tackle global health problems, it is
just as critical that we continue to invest in developing the next
generation of tools to stamp out disease and address current and
emerging threats. For instance, newer, more robust, and easier to use
antiretroviral drugs--particularly for infants and young children--are
needed to treat and prevent HIV, and even an AIDS vaccine that is 50
percent effective has the potential to prevent one million HIV
infections every year. Drug-resistant tuberculosis (TB) is on the rise
globally, including in the United States, however the only vaccine on
the market is insufficient at 90 years old, and most therapies
available today are more than 50 years old, extremely toxic, and too
expensive. New tools are also urgently needed to address fatal
neglected tropical diseases (NTDs) such as sleeping sickness, for which
diagnostic tools are inadequate and the few drugs available are toxic
or difficult to use. There are many very promising technology
candidates in the R&D pipeline to address these and other health
issues; however, these tools will never be available if the support
needed to continue R&D is not supported and sustained.
Research and U.S. global health efforts
The United States is at the forefront of innovation in global
health technologies. The U.S. government is involved in 200 of the 365
global health products currently in the pipeline, with the NIH and CDC
involved in much of this research.
NIH
The NIH has helped make the United States a leader in research
globally. Dr. Francis Collins, director of the NIH, has named global
health as one of the agency's five top priorities, and recent NIH
global health research activities helped lead to the development of the
first-ever microbicide gel effective in preventing HIV/AIDS and the
development of new tools to combat neglected diseases, including
vaccines for dengue fever and trachoma, as well as new drugs to treat
malaria and TB.
Under the purview of the NIH, NCATS was established to accelerate
new treatments and cures for diseases. NCATS has the potential to play
a much needed role in global health research, but we remain concerned
about the legislative mandate limiting NCATS in their clinical trial
work. NCATS is the only NIH center to be limited by a legislative
mandate in its clinical trial work. There is no risk of NCATS
duplicating the global health activities of private industry as this
sector does not typically target neglected diseases due to small
commercial markets. We hope you will consider removing this statutory
barrier. We must not lose traction on the investments made in global
health at NIH. Robust investment is needed to ensure that new global
health tools are available to address current and future health
challenges.
CDC
The CDC also plays a critical role in global health and contributes
to valuable surveillance and health research systems--strengthening
programs that ensure the sustainability of global health R&D. The work
of its scientists has led to major advancements against devastating
diseases, including the eradication of smallpox and early
identification of the disease that became known as AIDS. Within the
CDC, the efforts of the Center for Global Health and NCEZID are
critical to protecting lives and must be continued. Ongoing investments
in the development of new vaccines, drugs, microbicides and other tools
have the potential to greatly accelerate efforts to combat HIV/AIDS,
TB, malaria, diarrheal disease, pneumonia, and other less well known
diseases such as leishmaniasis, dengue fever, schistomiasis, hookworm,
sleeping sickness, and Chagas disease, as well as help prevent maternal
and reproductive health challenges.
Leveraging the private sector for innovation
The NIH, CDC, and other U.S. agencies involved in global health R&D
regularly collaborate with the private sector in developing,
manufacturing, and introducing important technologies such as those
described above through public-private partnerships, including product
development partnerships. These partnerships leverage public-sector
expertise in developing new tools, partnering with academia, large
pharmaceutical companies, the biotechnology industry, and governments
in developing countries to drive greater development of products for
neglected diseases in which private industries have not historically
invested. This unique model has generated 42 new global health products
and has enormous potential for continued success if robustly supported.
NIH Director Francis Collins has stated that such partnership is key to
the development of therapies and health tools based on NIH-funded
research.
Innovation as a smart economic choice
Global health R&D brings life-saving tools to those who need them
most. However, the benefits these efforts bring are much broader than
preventing and treating disease. Global health R&D is also a smart
economic investment in the United States, where it drives job creation,
spurs business activity, and benefits academic institutions. Biomedical
research, including global health, is a $100 billion enterprise in the
United States. Sixty-four cents out of every U.S. dollar invested in
global health R&D goes directly to U.S.-based researchers. In a time of
global financial uncertainty, it is important that the United States
support industries, such as global health R&D, which build the economy
at home and abroad.
An investment made today can help save significant money in the
future. The recently released meningitis A vaccine, MenAfriVac, is on
course to save nearly $570 million in healthcare costs over the next
decade. In addition, new therapies to treat drug-resistant TB have the
potential to reduce the price of TB treatment by 90 percent and cut
health system costs significantly. The United States has made smart
investments in research in the past that have resulted in lifesaving
breakthroughs for global health diseases, as well as important advances
in diseases endemic to the United States. We must now build on those
investments to turn those discoveries into new vaccines, drugs, tests,
and other tools.
Recommendations
In this time of fiscal constraint, support for global health
research that improves the lives of people around the world--while at
the same time creating jobs and spurring economic growth at home--
should unquestionably be among the Nation's highest priorities. In
keeping with this value, the GHTC respectfully requests that the
Committee do the following: 1) sustain and support U.S. investments in
global health research and product development and fully fund the NIH
at a level of at least $32 billion, and provide robust funding for the
CDC, with $464 million for the CDC Center for Global Health and $445
million for the NCEZID, 2) require leaders at the NIH, CDC, the FDA and
the Office of Global Affairs to collaborate with the U.S. Agency for
International Development, the State Department, the Department of
Defense, and Office of the U.S. Global AIDS Coordinator to develop a
cross-U.S. government global health R&D strategy to ensure that U.S.
investments in global health research are efficient, coordinated, and
streamlined, and 3) remove current statutory and legislative barriers
limiting NCATS' clinical trial mandate and require NCATS to develop and
report on a plan to include initiatives targeted at neglected diseases
and global health conditions. As a leader in science and technology,
the United States has the ability to capitalize upon our strengths to
help reduce illness and death and ultimately eliminate disabling and
fatal diseases for people worldwide, contributing to a healthier world
and a more stable global economy. Sustained investments in global
health research to develop new drugs, vaccines, tests, and other health
tools--combined with better access to existing methods to prevent and
treat disease--present the United States with an opportunity to
dramatically alter the course of global health while building political
and economic security across the globe. On behalf of the members of the
GHTC, I would like to extend my gratitude to the Committee for the
opportunity to submit written testimony for the record.
[This statement was submitted by Kaitlin Christenson, Coalition
Director, Global Health Technologies Coalition.]
______
Prepared Statement of the Government Relations Easter Seals, Inc.
Mr. Chairman and Members of the Subcommittee: Thank you for the
opportunity to speak on behalf of Easter Seals about our Federal
funding priorities for fiscal year 2015. Easter Seals is a national
nonprofit organization that provides essential community-based services
to individuals with disabilities, older adults, veterans and other
underserved populations to help them live, learn, work and contribute
to their communities. Easter Seals' top priorities are in the people we
serve like Arlena, Ben, Elijah and Donald whose lives have been
impacted or could be through Federal investments made by this
subcommittee. Easter Seals respectfully asks that you consider these
stories and the critical programs these individuals as the subcommittee
develops its fiscal year 2015 bill. Specifically Easter Seals requests
that the Senior Community Service Employment Program be funded at
$434,371,000 for fiscal year 2015, the Homeless Veterans' Reintegration
Program be funded at $50,000,000 for fiscal year 2015, the Early
Intervention Grants for Infants and Families be funded at $458,498,000
for fiscal year 2015, and the Department of Education Transition Model
System be funded at $15,000,000 for 2015.
Meet Arlena: Arlena is an older worker who is contributing to her
New Jersey community as a full-time security supervisor at a major
airport. Her success may have seemed out-of-reach less than 2 years
earlier when the 55-year-old single mother faced dual challenges.
Arlena had lost her temporary job and was out of work for about a year
when Hurricane Sandy hit and further complicated matters. She lost her
home and all of her belonging in the 2012 storm, which left her
homeless. She was forced to move in with her daughter's family.
Eventually her daughter moved and gave her the apartment. However, with
no job she fell behind in her rent and utilities. She turned to Easter
Seals for help after hearing about the Senior Community Service
Employment Program (SCSEP) through a friend. The Department of Labor
program supports employment of older workers by providing part-time,
paid community service positions and work-based training for
unemployed, low-income individuals, age 55 and older. Through the
Federal program, Easter Seals connected Arlena to supportive services
to help her maintain an apartment, boosted her computer skills and
matched her with on-the-job training at three different community
locations. After 9 months in the program, she applied for and secured
an entry level security position. Based on her previous work history,
Arlena was promoted to a supervisory position. SCSEP helped to provide
Arlena the tools and opportunities she needed to prove she could bounce
back from adversity and contribute again to her community. Easter Seals
asks that the subcommittee supports a fiscal year 2015 funding level of
$434,371,000 for SCSEP, the same level the program received in fiscal
year 2014.
Meet Ben: Ben was almost among the one million children under age 5
with disabilities who go undiagnosed every year. Ben's mom felt uneasy
about her son's language progress when he was 18 months. But her doctor
attributed the speech delays to being raised in a bilingual household.
After the birth of Ben's brother 6 months later, Ben's mom became more
concerned about Ben's development, this time related to his behavior.
``I knew that Ben needed help.'' So she reached out to her State's
Birth to Three program--which is funded through Part C of the
Individuals with Disabilities Education Act--and soon Ben was receiving
needed speech and occupational services from Easter Seals and was
diagnosed with a form of autism called PDD-NOS. Within 6 months of
receiving early invention services, Ben was able to communicate in
sentences. Now 4 years old, he continues to work hard and is making
enormous progress. As a result of these early intervention investments,
Ben continues to reach major milestones which will fundamentally change
his life and allow him to fully participate in his community. Easter
Seals asks that you increase funding by $20 million for the Part C
Early Intervention grants to $458,498,000 in fiscal year 2015 so more
children like Ben can access the services and supports they need when
they need them to succeed.
Meet Elijah: Elijah achieved academic success most parents dream
for their children. He was high school class valedictorian and a
college honors student with a Master's Degree. However, his transition
into the workplace has been challenging. He can't find a job. Elijah
lives with Asperger's syndrome and, in fact, benefited from early
intervention services through Easter Seals when he was a child.
However, Elijah has struggled during this adult transition,
particularly in job interviews where the repetitive nature of
Asperger's syndrome makes it challenging for him to stay succinct and
on track. Elijah is not alone. The Government Accountability Office
(GAO-12-594) found that students with disabilities face ``several
longstanding challenges'' during their transition from high school into
postsecondary education or the workforce. Among the challenges the GAO
cited was accessing services, such as transportation education and
travel instruction. The U.S. Department of Education has proposed in
its fiscal year 2015 budget to test a coordinated model of transition
planning, services, and supports through a new Transition Model System
(TMS). The goal of TMS is to help address the many challenges faced by
youth with disabilities like Elijah. Easter Seals asks that the
subcommittee to fully support the Administration's fiscal year 2015
funding request of $15,000,000 for the Transition Model System and asks
that you include report language to strengthen the connection and
importance of transportation education and travel instruction within
TMS to increase and improve postsecondary outcomes for students with
disabilities.
Meet Donald: Donald was a proud veteran of the Air National Guard
but--at age 48--he found himself unemployed for more than 5 years and
living on the street. Despite the national push to end homelessness
among veterans, far too many men and women who served our Nation like
Donald did are among the ranks of America's homeless. Donald was
connected to Easter Seals, who utilized the holistic, supportive
services care coordination model used in the Department of Labor's
Homeless Veterans Reintegration Program (HVRP) to help get Donald back
on his feet. Easter Seals connected Donald to transitional housing,
provided him with a monthly bus pass so he could easily attend required
meetings and trainings, and linked him to the local U.S. Department of
Veterans Affairs medical center for other services. Donald also
received individualized training and assistance in creating a resume
and cover letter and in updating his job search, networking and
interview skills. Based on his strengths and employment background,
Easter Seals assisted Donald in a series of temporary jobs through
staffing agencies, one of which turned into a full time permanent job,
with benefits, at a local manufacturing company. Donald cited
``networking skills, online job search assistance, resume update,
housing stabilization, reliable transportation, and encouragement'' as
key Easter Seals HVRP services that helped him get employed again. HVRP
is the only Federal nationwide program focusing exclusively on the
employment of veterans who are homeless. The program works, in large
part, due to the holistic, person-centered care coordination model that
Easter Seals has used for several decades in helping individuals with
disabilities achieve their dreams. Easter Seals asks that the
subcommittee supports the authorized level of $50,000,000 for HVRP in
fiscal year 2015.
Thank you for the opportunity to share with you Easter Seals'
appropriations priorities for the fiscal year 2015 Labor, Health and
Human Services, Education, and Related Agencies appropriations bill. We
hope that you consider these programs and the thousands of people with
disabilities, veterans and older adults who are fully participating and
contributing to their communities as a result of these early Federal
investments that continue to pay dividends. Thank you again for your
time and consideration.
[This statement was submitted by Katy Beh Neas, Senior Vice
President, Government Relations Easter Seals, Inc.]
______
Prepared Statement of the Harm Reduction Coalition
We are requesting $5 million for the Substance Abuse and Mental
Health Services Administration at the Center for Substance Abuse
Treatment, and $5 million for the Centers for Disease Control and
Prevention at the office of Unintentional Injury Prevention, to address
the opioid overdose epidemic.
The opioid overdose epidemic has reached crisis proportions in
recent years. The Centers for Disease Control and Prevention reports
that in 2010, opioids--including both prescription painkillers and
heroin--were responsible for nearly 20,000 overdose deaths. While
prescription painkillers continue to account for the majority of opioid
overdoses, deaths from heroin overdose increased by 45 percent between
2006 and 2010, fueling concerns in several parts of the country that
progress in reducing prescription painkiller misuse is being offset by
a dramatic rise in heroin use and its attendant social and health
consequences, including addiction, hepatitis C, and overdose. For
example, in Kentucky, a State on the forefront of comprehensive
approaches to the prescription drug overdose epidemic, the Kentucky
Injury Prevention and Research Center recently reported that while
overall drug overdose deaths have leveled off from 2011 to 2012 after a
decade of dramatic increases, promising declines in the number of
prescription painkiller deaths have been accompanied by a 207 percent
increase in heroin-related overdose deaths from 2011 to 2012.
For these reasons, Harm Reduction Coalition believes that as
efforts continue to mount a comprehensive response to prescription
painkiller overdoses, it is necessary to incorporate the intertwined
rise in heroin misuse and adopt a broader strategic framework to
address all opioids. An opioid epidemic framework would maintain and
intensify the array of activities such as those aimed at opioid
prescribing practices and monitoring programs, safe disposal, patient
and public education, regulatory and enforcement actions, and expansion
of effective addiction treatment and recovery services. At the same
time, the broader opioid epidemic framework recognizes the vital need
for additional public health interventions and opportunities, including
the role of expanded access to naloxone, alongside heightened attention
to the risks of hepatitis C and other blood-borne viruses transmissible
through injection drug use.
Naloxone is a generic medication which acts as an opioid
antagonist, blocking the effects of opioids such as painkillers or
heroin and capable of reviving individuals from opioid overdoses. A
substantial body of research and practice has demonstrated that
naloxone is safe and effective in the hands of laypersons; in the words
of Dr. Nora Volkow, Director of the National Institute on Drug Abuse,
``several experimental overdose education and naloxone distribution
(OEND) programs have issued naloxone directly to opioid users and their
friends or loved ones, or other potential bystanders, along with brief
training in how to use these emergency kits. Such programs have been
shown to be an effective, as well as cost-effective, way of saving
lives.''
Dr. Volkow cites data published by CDC showing that through 2010,
overdose education and naloxone distribution programs reported
preventing over 10,000 opioid overdose deaths across the country. As of
this month, eighteen States have passed legislation to facilitate
broader access and utilization of naloxone, ranging from Kentucky to
Connecticut, Ohio to California; Georgia passed naloxone legislation on
March 18th , which now awaits the governor's signature. These overdose
education and naloxone distribution programs vary in setting and scope.
In North Carolina, Project Lazarus trains physicians to co-prescribe
naloxone to pain patients receiving opioids. In Massachusetts, support
groups for parents with children struggling with opioid dependence are
trained and provided with naloxone. In Rhode Island, naloxone is
provided through pharmacies. In Kentucky, some of the strongest
advocates for naloxone have been the addiction recovery community. In
New York, my organization has provided naloxone training to dozens of
drug treatment programs, syringe exchange programs, shelters, and law
enforcement agencies. In other parts of the country, overdose education
and naloxone distribution programs are launching in emergency
departments, jails, and Veterans Administration Medical Centers.
These programs are gaining increased Federal attention; in the last
month, the Attorney General echoed the Office of National Drug Control
Policy in calling upon first responders and law enforcement officers to
be trained and equipped with naloxone. The Agency for Healthcare
Research and Quality highlighted the Massachusetts overdose education
and naloxone distribution program and featured accompanying quality
tools, including an overdose and naloxone program manual from the Harm
Reduction Coalition. Last year, the Substance Abuse and Mental Health
Services Administration (SAMHSA) released an opioid overdose toolkit
featuring naloxone. NIDA and FDA have worked to support and facilitate
the development of new, consumer-friendly formulations of naloxone. The
Ohio Department of Health's Violence and Injury Prevention Program has
used a portion of its CDC injury prevention funding to expand Project
DAWN, an overdose education and naloxone distribution program, to
additional counties.
The President's fiscal year 2015 budget requests $26 million to
prevent prescription drug overdose, of which $16 million would expand
CDC's Core Violence and Injury Prevention Program grants to States,
with an expected $10 million directed to prescription drug overdose
activities, and $10 million to SAMHSA would fund State planning grants
to develop prevention strategies for prescription drug abuse. The Harm
Reduction Coalition supports these proposals, and believes that these
resources would be valuable in establishing a foundation to reverse the
prescription drug overdose epidemic. We also believe that additional
emergency funding is necessary to stem the tide of opioid overdose from
both prescription opioids and, increasingly, heroin. Within the context
of a comprehensive approach to the opioid epidemic, including expanding
access to addiction treatment and recovery, the Harm Reduction
Coalition views the rapid expansion and scale up of overdose education
and naloxone distribution programs as an urgent and underfunded
priority to save lives.
To that end, we request that $5 million be provided to CDC Injury
Prevention and Control to support opioid overdose fatality prevention
efforts within State and local health departments and community-based
organizations to strengthen their ability to deliver overdose
recognition and intervention training and education, and expand access
to rescue medications and other evidence-based strategies. We also
request that $5 million be provided to SAMHSA's Center for Substance
Abuse Treatment to support community-based opioid overdose fatality
prevention efforts, with a focus on those initiatives that provide
overdose recognition and intervention training and education, access to
rescue medications, and facilitate linkage to treatment and recovery
services.
Across the country, emerging overdose education and naloxone
distribution programs rely on limited funding to meet a growing need.
The availability of targeted Federal funds through both the public
health and addiction treatment and recovery communities would hasten
the expansion of these programs to meet growing need and demand.
In the battle against opioid overdose, there is much to be done,
and no time to lose. We need a twofold approach of long-range efforts
to address the underlying causes and factors which led to the initial
rise in prescription opioid misuse, coupled with immediate actions to
avert additional deaths and tragedies in the short-term. As a person
who has lost friends and loved ones to opioid overdose, and listened to
the stories of grieving parents who only wish someone had told them
about naloxone before it was too late for their children, I
respectfully ask for your consideration of our requests.
If you have any questions, or would like more information or data
on naloxone, please feel free to contact: Daniel Raymond, Harm
Reduction Coalition. Thank you for your attention and consideration.
______
Prepared Statement of the Health Professions and Nursing Education
Coalition
The members of the Health Professions and Nursing Education
Coalition (HPNEC) are pleased to submit this statement for the record
recommending $520 million in fiscal year 2015 for the health
professions education programs authorized under Titles VII and VIII of
the Public Health Service Act and administered through the Health
Resources and Services Administration (HRSA).
HPNEC is an alliance of national organizations dedicated to
ensuring the healthcare workforce is trained to meet the needs of the
country's growing, aging, and diverse population. Titles VII and VIII
are the only federally-funded programs that seek to improve the supply,
distribution, and diversity of the health professions workforce, with a
focus on primary care and interdisciplinary training. By providing
educational and training opportunities to aspiring and practicing
health professionals, the programs also play a critical role in helping
the workforce adapt to meet the Nation's changing healthcare needs.
Titles VII and VIII are structured to allow grantees to test
educational innovations, respond to changing delivery systems and
models of care, and address timely topics in their communities. By
assessing the needs of the communities they serve, Titles VII and VIII
are well positioned to fill gaps in the workforce and increase access
to care for all populations. Further, the programs emphasize
interprofessional education and training, bringing together knowledge
and skills across disciplines to provide effective, efficient and
coordinated care.
While HPNEC recognizes the Subcommittee faces difficult decisions
in a constrained budget environment, a continued commitment to programs
supporting healthcare workforce development should remain a high
priority. The Nation faces a shortage of health professionals, which
will be exacerbated by the addition of millions of Americans to the
healthcare system. Failure to fully fund the Title VII and Title VIII
programs would jeopardize activities to fill these vacancies and to
prepare the next generation of health professionals.
The Title VII and Title VIII programs can be considered in seven
general categories:
--The Primary Care Medicine and Oral Health Training programs support
education and training of primary care professionals to improve
access and quality of healthcare in underserved areas. Two-
thirds of Americans interact with a primary care provider every
year. Over one-third of primary care providers trained through
these programs work in underserved areas, compared to 10
percent of those trained in other traditional programs. The
General Pediatrics, General Internal Medicine, and Family
Medicine programs provide critical funding for primary care
physician training in community-based settings and support a
range of initiatives, including medical student and residency
training, faculty development, and the development of academic
administrative units. The Rural Physician Training Grants focus
on increasing the number of medical school graduates practicing
in rural communities. The primary care cluster also provides
grants for Physician Assistant programs to encourage and
prepare students for primary care practice in rural and urban
Health Professional Shortage Areas. The General Dentistry,
Pediatric Dentistry, Dental Public Health, and Dental Hygiene
programs provide grants to dental schools, dental hygiene
schools, and hospitals to create or expand primary care dental
training.
--Because much of the Nation's healthcare is delivered in remote
areas, the Interdisciplinary, Community-Based Linkages cluster
supports community-based training of health professionals.
These programs are designed to encourage health professionals
to return to such settings after completing their training and
to encourage collaboration between two or more disciplines. The
Clinical Training in Interprofessional Practice program
supports interdisciplinary training opportunities that prepare
providers to deliver coordinated, efficient, and high-quality
care. The Area Health Education Centers (AHECs) offer clinical
training opportunities to health professions and nursing
students in rural and other underserved communities by
extending the resources of academic health centers to these
areas. AHECs improve health by leading the Nation in the
recruitment, training, and retention of a diverse health
workforce for underserved communities. By leveraging State and
local matching funds to form networks of health-related
institutions, AHECs also provide education services to
students, faculty, and practitioners. The Geriatric Health
Professions programs, including the Geriatric Academic Career
Award program and Geriatric Education Centers, are all designed
to bolster the number and quality of healthcare providers
caring for the rapidly growing number of older adults and to
expand geriatrics training to all healthcare professionals. For
example, the programs provide interprofessional education and
training on Alzheimer's disease and related dementias. The
Graduate Psychology Education (GPE) program is the Nation's
only Federal program dedicated solely to the education and
training of doctoral-level psychologists. GPE supports the
interprofessional training of doctoral-level psychology
students in providing supervised mental and behavioral health
services to underserved populations (i.e. older adults,
children, chronically ill, and victims of abuse and trauma,
including returning military personnel and their families) in
rural and urban communities. The Mental and Behavioral Health
Education and Training Grant Program supports the training of
psychologists, social workers, and child and adolescent
professionals. These programs together work to close the gap in
access to quality mental and behavioral healthcare services by
increasing the number of qualified mental health clinicians.
--The Minority and Disadvantaged Health Professionals Training
cluster helps improve healthcare access in underserved areas
and the representation of minority and disadvantaged
individuals in the health professions. Diversifying the
healthcare workforce is a central focus of the programs, making
them a key player in mitigating racial, ethnic, and socio-
economic health disparities. Further, the programs emphasize
cultural competency for all health professionals, an important
role as the Nation's population is growing and becoming
increasingly diverse. Minority Centers of Excellence support
increased research on minority health, establish educational
pipelines, and provide clinical experiences in community-based
health facilities. The Health Careers Opportunity Program helps
to improve the development of a competitive applicant pool
through partnerships with local educational and community
organizations and extends the healthcareers pipeline to the K-
12 level. The Faculty Loan Repayment and Faculty Fellowship
programs provide incentives for schools to recruit
underrepresented minority faculty. The Scholarships for
Disadvantaged Students supports students from disadvantaged
backgrounds who are eligible and enrolled as full-time health
professions students.
--The Health Professions Workforce Information and Analysis program
provides grants to institutions to collect and analyze data to
advise future decisionmaking on the health professions and
nursing programs. The Health Professions Research and Health
Professions Data programs have developed valuable, policy-
relevant studies on the distribution and training of health
professionals. The National Center for Workforce Analysis
performs research and analysis on health workforce issues,
including supply and demand, to help inform both public and
private decisionmaking.
--The Public Health Workforce Development programs help increase the
number of individuals trained in public health, identify the
causes of health problems, and respond to such issues as
managed care, new disease strains, food supply, and
bioterrorism. The Public Health Traineeships and Public Health
Training Centers seek to alleviate the critical shortage of
public health professionals by providing up-to-date training
for current and future public health workers, particularly in
underserved areas. Preventive Medicine Residencies, which do
not receive funding through Medicare GME, provide training in
the only medical specialty that teaches both clinical and
population medicine to improve community health. This cluster
also includes a focus on loan repayment as an incentive for
health professionals to practice in disciplines and settings
experiencing shortages. The Pediatric Subspecialty Loan
Repayment Program offers loan repayment for pediatric medical
subspecialists, pediatric surgical specialists, and child and
adolescent mental and behavioral health specialists, in
exchange for service in underserved areas.
--The Nursing Workforce Development programs under Title VIII provide
support for nursing students across the entire education
spectrum improve the access to, and quality of, healthcare in
underserved areas. These programs provide the largest source of
Federal funding for nursing education, providing loans,
scholarships, traineeships, and programmatic support that,
between fiscal year 2006 and 2012, supported over 450,000
nurses and nursing students as well as numerous academic
nursing institutions and healthcare facilities. Each year,
nursing schools turn away tens of thousands of qualified
applications at all degree levels due to an insufficient number
of faculty, clinical sites, classroom space, clinical
preceptors, and budget constraints. At the same time, the need
for nursing services and licensed, registered nurses is
expected to increase significantly over the next 20 years. The
Advanced Education Nursing program awards grants to train a
variety of nurses with advanced education, including clinical
nurse specialists, nurse practitioners, certified nurse-
midwives, nurse anesthetists, public health nurses, nurse
educators, and nurse administrators. Workforce Diversity grants
support opportunities for nursing education for students from
disadvantaged backgrounds through scholarships, stipends, and
retention activities. Nurse Education, Practice, and Retention
grants help schools of nursing, academic health centers, nurse-
managed health centers, State and local governments, and other
healthcare facilities to develop programs that provide nursing
education, promote best practices, and enhance nurse retention.
The Loan Repayment and Scholarship Program repays up to 85
percent of nursing student loans and offers full-time and part-
time nursing students the opportunity to apply for scholarship
funds in exchange for 2 years of practice in a designated
nursing shortage area. The Comprehensive Geriatric Education
grants are used to train nursing professionals who will provide
direct care to older Americans, develop and disseminate
geriatric curricula, train faculty members, and provide
continuing education. The Nurse Faculty Loan program provides a
student loan fund administered by schools of nursing to
increase the number of qualified nurse faculty.
--The loan programs under Student Financial Assistance support
financially disadvantaged health professions students. The
NURSE Corps supports undergraduate and graduate nursing
students with a preference for those with the greatest
financial need. The Primary Care Loan (PCL) program provides
loans in return for dedicated service in primary care. The
Health Professional Student Loan (HPSL) program provides loans
for financially needy health professions students based on
institutional determination. These programs are funded out of
each institution's revolving fund and do not receive Federal
appropriations. The Loans for Disadvantaged Students program
provides grants to institutions to make loans to disadvantaged
students.
Title VII and Title VIII programs guide individuals to high-demand
health professions jobs, helping individuals reach their goals and
communities fill their health needs. Further, numerous studies
demonstrate that the Title VII and Title VIII programs graduate more
minority and disadvantaged students and prepare providers that are more
likely to serve in Community Health Centers (CHC) and the National
Health Service Corps (NHSC).
The multi-year nature of health professions education and training,
coupled with provider shortages across many disciplines and in many
communities, necessitate a strong, continued, and reliable commitment
to the Title VII and Title VIII programs.
While HPNEC members understand the budget limitations facing the
Subcommittee, we respectfully urge support for $520 million for the
Title VII and VIII programs. We look forward to working with the
Subcommittee to prioritize the health professions programs in fiscal
year 2015 and into the future.
______
Prepared Statement of the HIV Medicine Association
The HIV Medicine Association (HIVMA) of the Infectious Diseases
Society of America (IDSA) represents more than 5,000 physicians,
scientists and other healthcare professionals who practice on the
frontline of the HIV/AIDS pandemic. Our members provide medical care
and treatment to people with HIV/AIDS in the U.S. and globally, lead
HIV prevention programs and conduct research that has led to the
development of effective HIV prevention and treatment options. We urge
you to invest in the medical research supported by the National
Institutes of Health and sustain and grow funding for the Ryan White
Program at the Health Resources and Services and Administration and the
Centers for Disease Control and Prevention's (CDC) HIV and STD
prevention programs.
Early access to effective HIV treatment helps patients with HIV
live healthy and productive lives and is cost effective.\1\ Treatment
not only saves the lives of individuals with HIV but has critical
benefits to public health in that it reduces risk of transmitting HIV
to near zero.\2\ However, despite our remarkable progress in HIV
prevention, diagnosis and treatment, HIV/AIDS remains a serious
epidemic in the United States with a record 1.1 million people living
with HIV and an estimated 50,000 new infections occurring annually. In
our country, HIV infection disproportionately impacts racial and ethnic
minority communities and low income people who depend on public
services for their life-saving healthcare and treatment. The rate of
new HIV infection in African Americans is 8 times that of whites based
on population size.\3\ Globally there are more than 35.3 million people
living with HIV, the great majority of them in Sub-Saharan Africa. We
are beginning to see improvements thanks in large part to U.S.
investments in programs like PEPFAR: HIV prevalence has leveled to
about 0.8 percent, the number of deaths have declined by 30 percent
since 2005 and new infections have declined by 33 percent since 2001.
Still there are 2.3 million new infections each year--more than 6,300
each day.
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\1\ Kitahata, Gange, Abraham, et al. Effect of early versus
deferred antiretroviral therapy for HIV on survival. New Engl J Med
2009;360:1815-26.
\2\ Cohen, Myron S., et al. Prevention of HIV-1 Infection with
Early Antiretroviral Therapy. 2011 New England Journal of Medicine 493-
505: V365, no 6, http://www.nejm.org/doi/full/10.1056/NEJMoa11052.
\3\ CDC Fact Sheet, February, 2014, accessed online at: http://
www.cdc.gov/hiv/risk/racialethnic/aa/facts/index.html.
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The funding requests in our testimony largely reflect the consensus
of the Federal AIDS Policy Partnership (FAPP), a coalition of HIV
organizations from across the country, and are estimated to be the
amounts necessary to mount an effective response to the domestic HIV
epidemic and meet the need in communities across the country.
National Institutes of Health (NIH)--Office of AIDS Research (OAR):
HIVMA strongly supports an fiscal year 2015 funding level of at least
$32 billion for the NIH, including at least $3.2 billion for the NIH
Office of AIDS Research. This level of funding is vital to sustain the
pace of research that will improve the health and quality of life for
millions of men, women and children in the U.S. and in the developing
world. Years of flat funding for biomedical research has eroded our
capacity to sustain our Nation's historic worldwide leadership in HIV/
AIDS research and innovation, and is discouraging cultivation of the
next generation of scientists.
Our past investment in comprehensive HIV/AIDS research paid off
enormously in dramatic gains that resulted in reductions in mortality
from AIDS of nearly 80 percent in the U.S. and in other countries where
treatment is available. This research also helped reduce the mother to
child HIV transmission rate from 25 percent to less than 1 percent in
the U.S. and to very low levels in other countries where treatment is
available.
Strong, sustained NIH funding is a critical national priority that
will foster better health, economic revitalization and help realize the
goals of the National HIV/AIDS Strategy. Sustained increases in funding
are also essential to train the next generation of scientists and
prepare them to make tomorrow's HIV discoveries. Congress should ensure
the Nation does not delay vital HIV/AIDS research progress.
HIV/AIDS Bureau of the Health Resources and Services
Administration: We strongly urge you to increase funding for the Ryan
White Program by $123.2 million in fiscal year 2015. For Ryan White
Part C programs in fiscal year 2015, we urge an allocation of at least
$225.1 million, or a $24 million increase over the fiscal year 2014
level for Part C. The comprehensive HIV care model or ``medical home''
that is supported by the Ryan White Program has been highly successful
at achieving positive clinical outcomes with a complex patient
population. The annual healthcare costs for HIV patients who are not
able to achieve viral suppression (often due to delayed diagnosis and
care) are nearly 2.5 times that of healthier HIV patients.\4\
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\4\ Based on data from Gilman BH, Green, JC. Understanding the
variation in costs among HIV primary care providers. AIDS
Care.2008:20;1050-6.
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The HIV medical clinics funded through Part C have been struggling
to meet the increased demand for patients making an increase in funding
critical to prevent additional staffing, laboratory and service cuts.
At a bare minimum, we strongly urge you to support an increase of $24
million over fiscal year 2014 appropriated funding for Ryan White Part
C.
While HIVMA welcomes the $4 million increase for Part C programs
proposed in the President's fiscal year 2015 budget, we are concerned
about the proposal to consolidate Ryan White Part D funding into Part
C. Our specific concerns include:
--Part D funding supports effective HIV care and treatment services
for vulnerable populations, including women and adolescents.
With adolescents accounting for 39 percent of new HIV
infections in the U.S., it is critical to target resources
effectively.
--A loss of a Part D program could reduce the community's access to
HIV care and treatment as programs are forced to compete or
consolidate with Part C clinics.
--Since most Ryan White medical clinics receive funding from multiple
parts of the Ryan White Program, reduction of funding to one
part can have damaging and unintended consequences to the
overall services provided.
While the ACA provides important new healthcare coverage options
for many patients, most health insurers fail to support the
comprehensive care and treatment necessary for many patients to manage
HIV infection. High cost sharing, benefit gaps and limited state uptake
of the Medicaid expansion necessitate a vital and ongoing role for the
Ryan White Program.
Center for Disease Control and Prevention's (CDC) National Center
for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP): HIVMA
strongly urges total fiscal year 2015 funding of $1.319 billion for the
CDC's NCHHSTP, an increase of $198.2 million over the fiscal year 2014
level, including increases of: $55.1 million for HIV prevention and
surveillance, $16.4 million for viral hepatitis and $57.4 million for
tuberculosis prevention. We also support a funding level of at least
$464.3 million for CDC's global health programs, which includes
resources for the agency's essential role in implementing PEPFAR
programs in developing Nations. We are especially concerned about flat
funding of CDC's global HIV programs, and request an increase of at
least $3.3 million to that line item for a total of $132 million.
Policy Riders--Remove the Harmful Ban on Federal Funding for
Syringe Exchange Programs: HIVMA strongly urges re-instatement in
fiscal year 2015 report language of policy previously enacted into law
in fiscal year 2010 and fiscal year 2011 allowing Federal funding to be
used for syringe exchange programs. Such action will support local
control by letting local communities make their own decisions about how
best to prevent new HIV and viral hepatitis infections. We cannot
afford to forego any of the scientifically proven tools in the HIV
prevention tool box if we are going to end AIDS in the U.S. and around
the globe.
Conclusion: Historically, our Nation has made significant strides
in responding to the HIV pandemic here at home and around the world,
but years of flat funding is now causing us to lose ground, as funding
priorities have shifted away from public health and research programs.
We must seize the opportunity to limit the toll of this deadly
infectious disease on our planet, to save the lives of millions who are
infected or at risk of infection here in the U.S. and around the globe,
and to realize the vision of an AIDS-free generation.
[This statement was submitted by Jeanne Keruly, MS, CRNP, Johns
Hopkins University, HIV Medicine Association.]
______
Prepared Statement of The Humane Society of the United States and the
Humane Society Legislative Fund
On behalf of The Humane Society of the United States (HSUS) and the
Humane Society Legislative Fund (HSLF), we appreciate the opportunity
to provide testimony on our top NIH funding priorities for the Senate
Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee in fiscal year 2015.
capacity at the national chimpanzee sanctuary for federally owned
chimpanzees retired by the national institutes of health
The HSUS and HSLF request NIH be given authority to use $5 million
of funds appropriated in this and subsequent appropriations bills for
extramural construction and renovation within the National Chimpanzee
Sanctuary System. In 2013, NIH announced their plan to retire hundreds
of government owned chimpanzees to sanctuary. This decision followed
years of scientific review which determined chimpanzees are not
necessary for research. Additional sanctuary construction is needed to
enable NIH to move forward with their plan to retire the vast majority
of government owned chimpanzees to sanctuary. Even with upfront
construction expenditures, transferring government owned chimpanzees
from laboratories to sanctuaries will save significant taxpayer funds
over the lifetimes of the chimpanzees due to the lower cost of
sanctuary care.
Further basis of our request can be found below.
Background information
In June of 2013, the National Institutes of Health announced their
plan to retire all but 50 government-owned chimpanzees to sanctuary,
significantly curtail the use of chimpanzees in NIH funded studies and
not to revitalize breeding of chimpanzees for research. These decisions
resulted from an Institute of Medicine study in 2011 which found that
chimpanzees are not necessary for the vast majority of research.
Immediately following the announcement of the IOM study results, NIH
accepted the findings and assembled a panel of experts to advise them
on the best way to implement the IOM findings. NIH ultimately accepted
nearly all of the expert panel's recommendations in their final
decision.
Prior to announcing their plan, NIH had already begun the transfer
of the 110 government owned chimpanzees at the New Iberia Research
Center in Louisiana to Chimp Haven (the National Chimpanzee Sanctuary),
also located in Louisiana. The transfer is expected to be completed by
the end of fiscal year 2014. At that point, approximately 350
government-owned chimpanzees will remain in laboratories--300 of whom
will be slated for retirement to sanctuary per NIH's plan.
In late November of 2013, the President signed into law amendments
to the Chimpanzee Health Improvement Maintenance and Protection (CHIMP
Act) which provided continued funding for the care, maintenance and
transportation of federally owned chimpanzees over the next 5 years.
These amendments have enabled NIH to use their funding judiciously by
continuing to support chimpanzees in sanctuary and also set the stage
for NIH to move forward with their plan to retire hundreds more
chimpanzees.
Costs in laboratories vs. sanctuary
Accredited sanctuaries provide the highest welfare standards for
chimps at a lower cost to taxpayers than housing chimpanzees in barren
labs (see chart below). It is estimated that transferring the 300
government-owned chimpanzees who are slated for retirement from the
laboratories where they are currently housed to the national sanctuary
would save taxpayers anywhere from $1.7 million to $2.7 million per
year in care and maintenance costs.
Construction to house more chimpanzees in sanctuary will require an
upfront expenditure. However, due to the lower per diem cost in
sanctuary, retiring chimpanzees to sanctuary will still yield a
significant savings to taxpayers over the long term. The sooner the
construction is completed and the chimpanzees are moved to sanctuary,
the more the government will save over the lifetimes of the
chimpanzees--which can be up to 60 years.
Estimated Costs Related to Care and Maintenance of Government Owned
Chimpanzees:
------------------------------------------------------------------------
NIH cost,
Number of millions in NIH cost, $/
Facility chimpanzees dollars/ chimpanzee/
year day
------------------------------------------------------------------------
Government Owned Chimpanzees in
Research Facilities and Research
Reserve Facilities
New Iberia Research Center... \1\ \2\ 59 \3\ 1.01 \4\ 46.7
Keeling Center for \2\ 147 \3\ 2.44 45.4
Comparative Medicine and
Research....................
Keeling Center for \2\ 16 \2\ 0.4 68.8
Comparative Medicine and
Research, DVR grant.........
Southwest National Primate \2\ 22 \3\ 0.65 80.9
Research Center, U42 grant
\5\.........................
Alamogordo Primate Facility.. \2\ 162 \2\ 3.60 61.3
Totals................... 406 8.10 \6\ 54.7
------------------------------------------------------------------------
\1\ The remaining 59 chimpanzees at New Iberia Research Center are
scheduled to be moved to Chimp Haven by the end of fiscal year 2014
\2\ Based on information available on NIH website regarding chimpanzee
maintenance costs for fiscal year 2014
\3\ Based on data available in NIH Research Portfolio Online Reporting
Tools (RePORT) for fiscal year 2014
\4\ Figure expected to increase significantly as chimpanzees move to
Chimp Haven and funds are spread over fewer chimpanzees
\5\ In addition to this grant, NIH also supports an additional 91
chimpanzees at the facility. These chimpanzees are owned by the
laboratory and are not under the control of NIH.
\6\ Average total.
------------------------------------------------------------------------
NIH cost,
Facility Number of millions in NIH cost, $/
chimpanzees dollar/year animal/day
------------------------------------------------------------------------
Government Owned Chimpanzees in
Sanctuary
Chimp Haven.................. \6\ 118-153 \7\ 1.7 30-39
------------------------------------------------------------------------
\6\ Fifty chimpanzees from New Iberia Research Center were transferred
to Chimp Haven during this contract year.
\7\ Unlike the other facilities, Chimp Haven has a cost reimbursement
contract in which they are reimbursed for costs incurred. This number
represents actual costs billed to NIH over the most recently completed
contract year (06/30/2012--06/29/2013)
We respectfully request the subcommittee to consider the following
language for inclusion in the appropriations bill:
Of the funds appropriated to NIH, $5,000,000 shall be for grants or
contracts for construction, renovation, or repair of the
sanctuary system established by Section 404K of the Public
Health Service Act.
We appreciate the opportunity to share our views for the Labor,
Health and Human Services, Education and Related Agencies
Appropriations Act for fiscal year 2015. We hope the Committee will be
able to accommodate this request. Thank you for your consideration.
high throughput screening, toxicity pathway profiling, and biological
interpretation of findings
national institutes of health--office of the director
In 2008, NIH, NIEHS and EPA signed a memorandum of understanding to
collaborate with each other to identify and/or develop high throughput
screening assays that investigate ``toxicity pathways'' that contribute
to a variety of adverse health outcomes (e.g., from acute oral toxicity
to long-term effects like cancer). In addition, the MOU recognized the
necessity for these Federal research organizations to work with
``acknowledged experts in different disciplines in the international
scientific community.'' Much progress has been made, including FDA
joining the MOU, but there is still a significant amount of research,
development and translational science needed to bring this vision
forward to where it can be used with confidence for safety
determinations by regulatory programs in the government and product
stewardship programs in the private sector. In particular, there is a
growing need to support research to develop the key science-based
interpretation tools which will accelerate using 21st century
approaches for predictive risk analysis. We believe the Office of the
Director at NIH can play a leadership role for the entire US government
by funding both extramural and intramural research.
We respectfully request the following committee report language as
a placeholder, which is supported by The HSUS, HSLF, and the American
Chemistry Council.
NIH Director
The Committee supports NIH's leadership role in modernizing the
approach for evaluating the safety of pharmaceuticals and chemicals
based on the incorporation of advanced molecular biological and
computational methods that envisions a move away from animal tests. NIH
has indicated that development of this science is critical to several
of its priorities, from personalized medicine to tackling specific
diseases such as cancer and diabetes and including critical initiatives
such as BRAIN and the National Center for Advancing Translational
Science. The Committee encourages NIH to continue to expand both its
intramural and extramural support for the use of human biology-based
experimental and computational approaches in health research to further
define human biology, disease pathways, and toxicity and to develop
tools for their integration into clinical strategies and safety
determination paradigms. Extramural and intramural funding should be
made available for the development and evaluation of the relevance and
reliability of human biology-based and pathway approaches and
prediction tools to assure readiness and utility for regulatory and
clinical applications, including pilot studies of pathway-based risk
assessments. The Committee requests an update on current activities, a
plan for future activities, and the fiscal year 2015 funding level for
this area of research in the fiscal year 2016 congressional budget
justification.
______
Prepared Statement of the Infectious Diseases Society of America's
On behalf of the Infectious Diseases Society of America (IDSA), I
am pleased to provide testimony in support of the U.S. Department of
Health and Human Services (HHS) components that work to prevent, detect
and treat infectious diseases (ID). IDSA represents more than 10,000 ID
physicians and scientists devoted to patient care, prevention, public
health, education, and research. As communicated to the full Senate
Appropriations Committee through testimony for the record in advance of
its April 29th hearing ``Driving Innovation through Federal
Investments,'' IDSA recommends increased fiscal year 2015 Federal
investments in public health and biomedical research to save lives,
contain healthcare costs, and promote economic growth. More
specifically, IDSA encourages the Subcommittee to provide a program
level of $7.8 billion for the Centers for Disease Control and
Prevention (CDC) as well as $32 billion for the National Institutes of
Health (NIH). IDSA is particularly supportive of the proposed CDC
Detect and Protect Against Antibiotic Resistance Initiative and
requests that it be fully funded at $30 million. We ask that the
Subcommittee also advance fiscal year 2015 appropriations that reflect
the national security and public health significance of the Biomedical
Advanced Research and Development Authority (BARDA). All of these
investments are a necessary part of a Federal strategy to decrease the
incidence and fatality of infectious diseases in our population.
centers for disease control and prevention
The ID community's partnership with the CDC has never been more
necessary, as we work to address the public health crisis of rising
antibiotic resistance while continuing efforts in other important areas
such as increasing immunization rates and slowing the spread of HIV.
Last fall, CDC issued a report, Antibiotic Resistance Threats in
the United States, 2013 that for the first time ranked and detailed the
threats posed by antibiotic resistant microbes. Conservative estimates
reveal that more than two million Americans suffer antibiotic resistant
infections each year, which result in approximately 23,000 deaths. The
actual numbers are likely far higher, as our surveillance and data
collection capabilities cannot yet capture the full disease burden.
These infections due to antibiotic resistant microbes cost tens of
billions of dollars to the U.S. healthcare system annually, and the
problem is worsening. The CDC recommended actions in four core areas to
address the problem, including prevention, tracking, antibiotic
stewardship, and development of new antibiotics and rapid diagnostics.
The CDC has proposed fiscal year 2015 activities in each of these
areas.
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
The NCEZID plays a leading role in CDC efforts to address
antibiotic resistance. As such, we ask that it be provided at least the
$445 million requested by the Administration, including at least $30
million for the Detect and Protect Against Antibiotic Resistance
Initiative. This initiative, which is supported by many stakeholders in
the health community, would establish regional prevention
collaboratives to implement best practices for antibiotic use and
infection prevention, create a detection network of five regional labs
to speed up identification of the most concerning threats, improve
antibiotic stewardship, and develop an isolate library that will help
facilitate the development of desperately needed new antibiotics and
diagnostics. The initiative directly addresses the recommended actions
from the CDC 2013 report. The CDC projects that over 5 years the
initiative will lead to a 50 percent reduction in health-care
associated Clostridium difficile (C. diff), 50 percent decline in
health-care associated carbapenem-resistant Enterobacteriaceae (CRE),
30 percent decline in invasive methicillin-resistant Staphylococcus
aureus (MRSA), 30 percent decline in health-care associated drug-
resistant Pseudomonas sp., and 25 percent reduction in drug-resistant
Salmonella infections. These bacteria claim thousands of lives
annually. CRE, for one, have become resistant to all or nearly all
currently available antibiotics. Further, nearly 50 percent of those
who develop bloodstream infections from CRE die.
IDSA and numerous other stakeholders support the proposed $14
million increase for the National Healthcare Safety Network (NHSN),
which would increase the number of healthcare facilities reporting
antibiotic use and antibiotic resistance data and would develop and
evaluate new infection prevention strategies.
IDSA thanks Congress for funding the Advanced Molecular Detection
(AMD) initiative in fiscal year 2014 and recommends that at least $30
million be allocated for it in fiscal year 2015. AMD strengthens CDC's
molecular sequencing tools and bioinformatics capacity to more rapidly
and accurately detect infectious diseases and resistance.
A recent World Health Organization report on antimicrobial
resistance reiterates that we are in the midst of a public health
crisis that is impacting all regions of the world and requires
immediate action on the part of governments and society. IDSA applauds
the Administration for launching a Global Health Security Agenda, which
would strengthen the capacity of nations to prevent, detect and slow
the spread of infectious diseases across borders, simultaneously
reducing threats to the United States. We ask that you provide the
initiative with funding allocated in the fiscal year 2015 PBR.
National Center for Immunization and Respiratory Diseases (NCIRD)
We know that vaccines are among the most cost-effective clinical
preventative services. However, according to the February 2014 CDC
Morbidity and Mortality Weekly Report (MMWR), adult immunization rates
remain low for most routinely recommended vaccines and considerably
short of Healthy People 2020 targets. Each year in the United States,
more than 40,000 adults die from illnesses that are preventable through
vaccination.
IDSA opposes the $51 million program level reduction to the CDC
Immunization Grant Program (Section 317) contained in the PBR. Although
the Affordable Care Act requires insurers to cover immunizations, this
alone will not guarantee access or utilization. The Section 317 funds
are critical to help providers obtain and store vaccines; establish and
maintain vaccine registries; as well as to educate providers and the
public about vaccine recommendations, effectiveness and safety; and
promote universal vaccination of healthcare workers.
CDC plays a critical role in seasonal and pandemic influenza
preparedness and response, including conducting important surveillance
activities that better inform response efforts and providing public
communications regarding influenza prevention and treatment. Lack of
sufficient funding for these efforts could lead to an increased
incidence and severity of influenza, as well as increased
hospitalization costs and mortality. In the long term, continuously
funded efforts will be more cost-effective than the periodic emergency
supplemental funding approach that historically has been used to fund
such efforts. IDSA supports the proposed fiscal year 2015 increase of
$15 million for these efforts.
national institutes of health
National Institute of Allergy and Infectious Diseases (NIAID)
Within NIH, we believe that the National Institute of Allergy and
Infectious Diseases (NIAID) should be funded at least at the $4.58
billion requested by the Administration in the fiscal year 2014 PBR.
Nearly flat-funding NIAID limits investment in new research and serves
as a disincentive for young people to pursue ID research careers so
critical to the discovery of new therapies, new diagnostic approaches,
and new preventive strategies.
The NIAID recently began funding a new clinical trials network
focused on antibiotic-resistant bacterial infections. With sufficient
funding, the new research network/infrastructure will conduct critical
studies to address antibiotic resistance as well as begin to answer
questions that will help fill the nearly empty antibiotic R&D pipeline.
Severe economic disincentives have caused a mass exodus of private
companies from the antibiotics market, making federally funded research
in this area more critical than ever. An IDSA report issued in April
2013 identified only seven new drugs in development for the treatment
of infections caused by multidrug-resistant Gram-negative bacilli
(GNB). The Transatlantic Task Force on Antimicrobial Resistance
(TATFAR) also recently issued a report, which identified the broken
pipeline of new antibacterial drugs as a key obstacle in dealing with
resistance. The TATFAR report highlighted NIAID support of clinical
research aimed at filling gaps in drug R&D and lowering the associated
economic risk to industry. We applaud NIAID's initiative in launching
the new network. However, IDSA recommends increased investment in this
area.
A recent IDSA report, Better Tests, Better Care: Improved
Diagnostics for Infectious Diseases, highlighted the need for
advancements in diagnostic tools to address bacterial, viral and fungal
infections and recommends strengthened NIAID funding for this priority.
Faster, more accurate diagnostics lead to better treatments and
improved patient outcomes. In addition, new diagnostics are needed to
identify patients with highly contagious illnesses so that containment
and prevention measures can be undertaken. Diagnostics can improve
physicians' ability to discern which infections need antibiotics, and
thereby help reduce the unnecessary use of antibiotics that drives the
development of antibiotic resistance.
assistant secretary for preparedness and response (aspr)
Biomedical Advanced Research and Development Authority (BARDA)
ASPR plays a key leadership role in coordinating Federal efforts to
sufficiently protect the Nation from biothreats, pandemics and emerging
infections. IDSA recommends increased funding for BARDA, which has been
flat-funded for several years. Additional investment in medical
countermeasure development is critical to prepare for both intentional
attacks and naturally emerging infections. BARDA is a critical source
of funding for public-private collaborations for antibiotic, diagnostic
and vaccine R&D.
We ask that the Subcommittee move forward with a sense of urgency
to bolster Federal initiatives aimed at dealing with issues such as
antimicrobial resistance, antibiotics and rapid diagnostics R&D, adult
immunizations, and biodefense. The appropriation of sufficient fiscal
year 2015 resources to address ID issues is a necessary complement to
efforts that are currently underway within the Senate and House
authorizing committees.
Thank you for the opportunity to submit this statement on behalf of
the Nation's ID physicians and scientists. Please forward any questions
to Jonathan Nurse.
[This statement was submitted by Jonathan Nurse, Director,
Government Relations, Public Policy and Government Relations,
Infectious Diseases Society of America.]
______
Prepared Statement of the International Foundation for Functional
Gastrointestinal Disorders
_______________________________________________________________________
--$32 Billion for the National Institutes of Health (NIH) at an
increase of $1 billion over fiscal year 2012. Increase funding
for the National Cancer Institute (NCI), The National Institute
of Diabetes and Digestive and Kidney Diseases (NIDDK) and the
National Institute of Allergy and Infectious Diseases (NIAID)
by 12 percent.
--Continue focus on Digestive Disease Research and Education at NIH,
Including), Irritable Bowel Syndrome (IBS), Fecal Incontinence
Gastroesophageal Reflux Disease (Gerd) Gastroparesis, and
Cyclic Vomiting Syndrome (CVS).
_______________________________________________________________________
Thank you for the opportunity to present the views of the
International Foundation for Functional Gastrointestinal Disorders
(IFFGD) regarding the importance of functional gastrointestinal and
motility disorders (FGIMD) research. Established in 1991, IFFGD is a
patient-driven nonprofit organization dedicated to assisting
individuals affected by FGMIDs, and providing education and support for
patients, healthcare providers, and the public. IFFGD also works to
advance critical research on FGIMDs in order to develop better
treatment options and to eventually find cures. IFFGD has worked
closely with the National Institutes of Health (NIH) on many
priorities, and I served on the National Commission on Digestive
Diseases (NCDD), which released a long-range plan in 2009, entitled
Opportunities and Challenges in Digestive Diseases Research:
Recommendations of the National Commission on Digestive Diseases.
The need for increased research, more effective and efficient
treatments, and the hope for discovering a cure for FGIMDs are close to
my heart. My own experiences of suffering from FGIMDs motivated me to
establish IFFGD, and I was shocked to discover that despite the high
prevalence of FGIMDs among all demographic groups, such a lack of
research existed. This translates into a dearth of diagnostic tools,
treatments, and patient supports. Even more shocking is the lack of
awareness among the medical community and the public, leading to
significant delays in diagnosis, frequent misdiagnosis, and
inappropriate treatments including unnecessary surgery. Most FGIMDs
have no cure and limited treatment options, so patients face a lifetime
of chronic disease management. The costs associated with these diseases
range from $25-$30 billion annually; economic costs are also reflected
in work absenteeism and lost productivity.
irritable bowel syndrome
IBS affects 30 to 45 million Americans, conservatively at least 1
out of every 10 people. It is a chronic disease that causes abdominal
pain and discomfort associated with a change in bowel pattern, such as
diarrhea and/or constipation. As a ``functional disorder,'' IBS affects
the way the muscles and nerves work, but the bowel does not appear to
be damaged on medical tests. Without a diagnostic test, IBS often goes
undiagnosed or misdiagnosed for years. Even after IBS is identified,
treatment options are limited and vary from patient to patient. Due to
persistent pain and bowel unpredictability, individuals may distance
themselves from social events and work. Stigma surrounding bowel habits
may act as barrier to treatment, as patients are not comfortable
discussing their symptoms with doctors. Many people also dismiss their
symptoms or attempt to self-medicate with over-the-counter medications.
Outreach to physicians and the general public remain critical to
overcome these barriers to treatment and assist patients.
fecal incontinence
At least 12 million Americans suffer from fecal incontinence.
Incontinence crosses all age groups, but is more common among women and
the elderly of both sexes. Often it is associated with neurological
diseases, cancer treatments, spinal cord injuries, multiple sclerosis,
diabetes, prostate cancer, colon cancer, and uterine cancer. Causes of
fecal incontinence include: damage to the anal sphincter muscles,
damage to the nerves of the anal sphincter muscles or the rectum, loss
of storage capacity in the rectum, diarrhea, or pelvic floor
dysfunction. People may feel ashamed or humiliated, and most attempt to
hide the problem for as long as possible. Some don't want to leave the
house in fear they might have an accident in public; they withdraw from
friends and family, and often limit work or education efforts.
Incontinence in the elderly is the primary reason for nursing home
admissions, an already significant social and economic burden in our
aging population. In 2002, IFFGD sponsored a consensus conference
entitled, Advancing the Treatment of Fecal and Urinary Incontinence
Through Research: Trial Design, Outcome Measures, and Research
Priorities. IFFGD also collaborated with NIH on the NIH State-of-the-
Science Conference on the Prevention of Fecal and Urinary Incontinence
in Adults in 2007.
NIDDK recently launched a Bowel Control Awareness Campaign (BCAC)
that provides resources for healthcare providers, information about
clinical trials, and advice for individuals suffering from bowel
control issues. The BCAC is an important step in reaching out to
patients, and we encourage continued support for this campaign. Further
research on fecal incontinence is critical to improve patient quality
of life and implement the research goals of the NCDD.
gastroesophageal reflux disease
GERD is a common disorder which results from the back-flow of
stomach contents into the esophagus. GERD is often accompanied by
chronic heartburn and acid regurgitation, but sometimes the presence of
GERD is only revealed when dangerous complications become evident.
There are treatment options available, but they are not always
effective and may lead to serious side effects. Gastroesophageal reflux
(GER) affects as many as one-third of all full term infants born in
America each year and even more premature infants. GER results from
immature upper gastrointestinal motor development. Up to 8 percent of
children and adolescents will have GER or GERD due to lower esophageal
sphincter dysfunction and may require long-term treatment.
gastroparesis
Gastroparesis, or delayed gastric emptying, refers to a stomach
that empties slowly. Gastroparesis is characterized by symptoms from
the delayed emptying of food, namely: bloating, nausea, vomiting, or
feeling full after eating only a small amount of food. Gastroparesis
can occur as a result of several conditions, and is present in 30
percent to 50 percent of patients with diabetes mellitus. A person with
diabetic gastroparesis may have episodes of high and low blood sugar
levels due to the unpredictable emptying of food from the stomach,
leading to diabetic complications. Other causes of gastroparesis
include Parkinson's disease and some medications. In many patients the
cause cannot be found and the disorder is termed idiopathic
gastroparesis.
cyclic vomiting syndrome
CVS is a disorder with recurrent episodes of severe nausea and
vomiting interspersed with symptom free periods. The periods of
intense, persistent nausea and vomiting, accompanied by abdominal pain,
prostration, and lethargy, last hours to days. Previously thought to
occur primarily in pediatric populations, it is increasingly understood
that this crippling syndrome can occur in many age groups, including
adults. CVS patients often go for years without correct diagnosis. CVS
leads to significant time lost from school and from work, as well as
substantial medical morbidity. The cause of CVS is not known. Research
is needed to help identify at-risk individuals and develop more
effective treatment strategies.
support for critical research
IFFGD urges Congress to fund the NIH at level of $32 billion for
fiscal year 2015. Strengthening and preserving our Nation's biomedical
research enterprise fosters economic growth and supports innovations
that enhance the health and well-being of the Nation. Concurrent with
overall NIH funding, IFFGD supports the growth of research activities
on FGIMDs to strengthen the medical knowledge base and improve
treatment, particularly through the National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK). Such support would expedite the
implementation of recommendations from the NCDD. It is also vital for
NIDDK to work with the National Institute of Child Health and Human
Development (NICHD) to expand its research on the impact FGIMDs have on
pediatric populations. Following years of near level-funding, research
has been negatively impacted across all NIH Institutes and Centers.
Without additional funding, medical researchers run the risk of losing
promising research opportunities that could benefit patients.
We applaud the recent establishment of the National Center for
Advancing Translational Sciences (NCATS) at NIH. Initiatives like the
Cures Acceleration Network are critical to overhauling the
translational research process and overcoming the challenges that
plague treatment development. In addition, new efforts like taking the
lead on drug repurposement hold the potential to speed new treatment to
patients. We ask that you support NCATS and provide adequate resources
for the Center in fiscal year 2015.
Thank you for the opportunity to present these views on behalf of
the FGIMD community.
[This statement was submitted by Nancy J. Norton, President and Co-
Founder, International Foundation for Functional Gastrointestinal
Disorders.]
______
Prepared Statement of the Interstate Mining Compact Commission
We are writing in opposition to the fiscal year 2015 Budget Request
for the Mine Safety and Health Administration (MSHA), which is part of
the U.S. Department of Labor. In particular, we urge the Subcommittee
to reject MSHA's proposed de-funding of the Assistance to States grant
program pursuant to Section 503(a) of the Mine Safety and Health Act of
1977. Until fiscal year 2013, MSHA's budget request for state grants
was approximately $9 million, which approached the statutorily
authorized level of $10 million, but still did not fully consider
inflationary and programmatic increases being experienced by the
states. In fiscal year 2015, based on a realignment of priorities, MSHA
has once again chosen to zero out funding for state assistance grants
as it did in fiscal year 2014. We urge the Subcommittee to restore
funding to the statutorily authorized level of $10 million for state
grants so that states are able to fully and effectively carry out their
responsibilities under Sections 502 and 503 of the Act, including the
training of our Nation's miners.
The Interstate Mining Compact Commission is a multi-state
governmental organization that represents the natural resource,
environmental protection and mine safety and health interests of its 26
member states. The states are represented by their Governors who serve
as Commissioners.
IMCC is greatly appreciative of actions by Congress in January of
this year as part of the Omnibus Appropriation bill for fiscal year
2014 to reject MSHA's proposed elimination of funding for the state
grants program and to restore funding at the fiscal year 2012 level of
$8.4 million. Given that action and the clear message it sent about the
importance of state mine safety programs, we had hoped the
Administration would respond accordingly and include funding for these
programs in its fiscal year 2015 proposed budget. Clearly, this did not
happen and as such we appeal to your Subcommittee to once again restore
funding for these vital miner health and safety programs.
It should be kept in mind that, whereas MSHA over the years has
narrowly interpreted Assistance to States grants as meaning ``training
grants'' only, Section 503 was structured to be much broader in scope
and to stand as a separate and distinct part of the overall mine safety
and health program. In the Conference Report that accompanied passage
of the Federal Coal Mine Health and Safety Act of 1969, the conference
committee noted that both the House and Senate bills provided for
``Federal assistance to coal-producing States in developing and
enforcing effective health and safety laws and regulations applicable
to mines in the States and to promote Federal-State coordination and
cooperation in improving health and safety conditions in the Nation's
coal mines.'' (H.Conf. Report 91-761). The 1977 Amendments to the Mine
Safety and Health Act expanded these assistance grants to both coal and
metal/non-metal mines and increased the authorization for annual
appropriations to $10 million. The training of miners was only one part
of the obligation envisioned by Congress.
With respect to the training component of our mine safety programs,
IMCC's member states are concerned that without full, stable funding of
the State Grants Program, the federally required training for miners
employed throughout the U.S. will greatly suffer. States have struggled
to maintain efficient and effective miner training programs in spite of
increased numbers of trainees and the incremental costs associated
therewith. The situation has been further complicated by new statutory,
regulatory and policy requirements that have grown out of the various
reports and recommendations attending the Upper Big Branch
investigation. In spite of all this, MSHA has chosen to eliminate
funding completely for this critical component of its statutory
obligations. In addition to state training programs, these assistance
grants also support state mine rescue training programs, mine rescue
competitions, EMT training, miner certifications, accident
investigations and reporting, review and approval of company safety
plans, and, for those states that operate more comprehensive mine
safety and health programs (such as PA, WV, VA, OH, IL, AL, KY and OK),
program administrative costs such as supplies, staff training, and
travel. We can provide a breakdown of these costs at the Committee's
request.
In MSHA's budget justification document (at page 70), the agency
states that: ``Training plays a critical role in preventing deaths,
injuries, and illnesses on the job. By providing effective training,
miners are able to recognize possible hazards and understand which
procedures are safe to follow. MSHA will continue to increase
visibility and emphasize on [sic] training, recognizing its critical
role in reducing the number of injuries and fatalities in the mining
community.'' We are mystified about how MSHA intends to accomplish
these stated objectives without the training and other programs that
are provided by the states pursuant to the grants they receive from
MSHA--as has been the case since the enactment of the Mine Safety and
Health Act in 1969.
By way of an explanation for the drastic cut to state grants, MSHA
states on page 72 of its budget justification document: ``To meet the
demand of the agency's higher priority enforcement activities, MSHA
will defund the program and shift the responsibility for training back
to mine operators. Mine operators will be required to develop their own
programs or contract these services. MSHA is transitioning to an
updated training model, and will develop more of its own training
curricula, exercises, and materials to assist mine operators with
providing a complete training program to their employees. Consistent
with existing statutory requirements, mine operators are required to
ensure that employees have access to complete training programs.''
While this idea of shifting training responsibilities and costs
entirely to mine operators may have merit in limited cases, we are
uncertain about the ability of the mining industry (especially small
operators and contractors) to accommodate these new costs and suspect
that any realignment of training responsibilities from the states to
the industry will take considerable time and planning. Furthermore, our
experience over the past 35 years has demonstrated that the states are
often in the best position to design and offer this training in a way
that insures that the goals and objectives of Sections 502 and 503 of
the Mine Safety and Health Act are adequately met. There is clear and
tangible evidence of training programs offered by mine operators (or
contractors on their behalf) falling well below what would be
considered a minimum standard for these types of programs. Furthermore,
there have never been any suggestions or allegations that the states
are not already providing the necessary ``training curricula, exercises
and materials to assist mine operators with providing a complete
training program''. MSHA appears to be playing the ``training card'' in
its budget justification to duplicate the excellent work that has
already been undertaken by the states in this area solely to increase
funding for MSHA staff.
There have been limited, and not particularly productive,
discussions between MSHA and the states about the impacts this proposal
will have on state training programs and other components of state mine
safety and health programs, including any sort of transition away from
how we are currently doing business. To propose such a dramatic shift
without first working out the details with the states is inappropriate
and a denigration of the role the states have played in protecting our
Nation's miners. Furthermore, to expect such a drastic change to occur
within a single fiscal year is unrealistic and will only result in
confusion and potential negative impacts to the availability and
quality of miner training and the overall health and safety of miners.
MSHA notes in its budget justification document that the State
Grants Program trained 132,000 miners in 48 states and the Navajo
Nation in fiscal year 2013, a year in which state grants were cut by 66
percent. While MSHA does not admit to what the elimination of this
funding will mean for miner training, we believe the consequences could
be debilitating. Examples of the direct impacts being reported by just
some of the IMCC member states as a result of MSHA's decision follow.
More expanded information from each state is appended to this statement
and we request that it be included in the record. The most recent
accounting of the number of miners trained by the states (and whose
training could be jeopardized by funding cuts) based on fiscal year
2012 reporting for coal and metal/nonmetal is as follows:
--Kentucky: Trained or tested over 25,000 people.
--Louisiana: 1,000 miners trained.
--Alaska: 2,343 miners trained.
--New Mexico: 2,265 miners trained.
--Oklahoma: 5,000 miners trained.
--Pennsylvania: 7,000 miners trained.
--Ohio: 8,443 miners trained (including for mine rescue).
--Colorado: 4,229 miners trained.
--Arkansas: 2,000 miners trained.
--Nevada: 2,700 miners trained.
--North Carolina: 6,000--8,000 miners trained.
--Maryland: 776 miners and contractors trained.
--Arizona: 3,056 miners trained.
--Virginia: 5,455 miners trained.
Interestingly, while MSHA is proposing to eliminate funding for
state training grants, it is proposing to increase funding by
$2,800,000 and 18 FTEs for its Educational and Policy Development
budget activity. This money will allegedly be used to transition from
state grants to a ``new training model'' which will include new
training curricula, materials and online courses, as well as monitoring
operator training plans and instructors. From our perspective, this
reflects an acknowledgement on MSHA's part that the transition to a
totally industry-lead training initiative will likely be fraught with
difficulties. However, heavy-handed Federal oversight is not the
solution to an effective training program. We have seen this type of
approach fail in the past and assert that the training programs
operated by the states have resulted in a higher level of success, as
indicated by the significantly reduced rates of injuries and fatalities
over the past several years. Congress has clearly understood this
dynamic as well, appropriating the necessary moneys needed to preserve
and enhance state training programs. It should also be kept in mind
that effective training programs operated by the states, especially for
small operators, are the first and best method to reduce accidents,
injuries and fatalities in mines. On the other hand, enforcement often
comes too late to be effective, and by its very nature is not
preventative. We are hopeful that Congress will once again recognize
these operational realities in fiscal year 2015 and turn back MSHA's
efforts to undercut these valuable programs.
While we can appreciate MSHA's desire to realign its resources to
focus on inspection and enforcement, one of the most effective ways to
insure miner health and safety in the first place is through
comprehensive and excellent training. The states have been in the
forefront of providing this training for over 35 years and are best
positioned to continue that work into the future. Furthermore, the
Federal government's relatively modest investment of money in
supporting the states to handle this training has paid huge dividends
in protecting lives and preventing injuries. The states are also able
to provide these services more effectively and at a cost well below
what it would cost MSHA to do so.
As you consider our request to reject MSHA's proposed cut and
instead to increase MSHA's budget for state assistance grants, please
keep in mind that the states play a particularly critical role in
providing special assistance to small mine operators (those coal mine
operators who employ 50 or fewer miners or 20 or fewer miners in the
metal/nonmetal area) in meeting their required training needs. This has
been a particular focus in those states where metal/non-metal mining
operations predominate. These are often small business operators who
cannot afford to offer the comprehensive training that is required
under Section 502 of the Mine Safety and Health Act. The states also
provide specialized training to the Spanish-speaking communities in the
western United States.
The ``yo-yo'' effect of inconsistent funding for state assistance
grants is having a debilitating effect on the way we do business. To
run effective, meaningful programs, states need continuous, stable,
reliable and sustainable funding from year to year. We greatly
appreciate your efforts to make that happen. We also appreciate the
opportunity to submit our views on MSHA's fiscal year 2015 budget
request. Please contact us for additional information or to answer any
questions you may have.
State Reports re Impacts from De-Funding of Assistance to States
Grants Program
In preparation for IMCC's presentation of this statement to the
House and Senate Appropriations Committees, IMCC asked the states three
questions, noted below. Responses from each of the reporting states are
indicated.
What do you anticipate the impacts to your state will be from the
elimination of grant funding, including the number of miners
who may not be trained?
--Kentucky: These cuts will have a devastating effect on our program.
Kentucky trains over 20,000 miners yearly. The money we get
from MSHA pays our instructors' salaries.
--Louisiana: In Louisiana, the state training is performed through
the Louisiana Technical Community College system. If the grant
is eliminated, their mine safety training program would be
completely eliminated, closing its doors on Sept 30, 2013, and
laying off both of its employees. The program trains at least
1,000 miners each year (886 miners from Oct 1, 2012 to
present).
--Alaska: Eliminating MSHA training funding potentially impacts each
of the 16,400 employees and thousands of owner/operators and
contractors working in Alaska's mining industry as of January
2013. Up to 2,600 students are MSHA trained and certified each
year by the University of Alaska Mine and Petroleum Training
Service (``MAPTS''). MAPTS is the MSHA training grant recipient
in Alaska. MAPTS staff have pointed out that a loss of MSHA
training grant funds will have a disparate impact on small
mines located in more remote areas of Alaska.
--New Mexico: In prior years the State of New Mexico, through New
Mexico Institute of Mining and Technology, received $147,000
from MSHA that was used to train miners in NM to meet the
regulatory requirements of 30 CFR Parts 46 and 48 which are
mandated training requirements for miners. We train over 2,000
miners in NM yearly. Most of these miners are employed at small
business operations in our state that cannot afford trainers at
their small operations. In addition we provide Spanish language
training to 200-300 miners yearly and are the only service
available to Spanish-speaking miners in the State.
--Oklahoma: The Oklahoma Miner Training Institute (OMTI) is funded in
part with the state grant. Utilizing the funding provided, OMTI
trains 5,000 miners annually in a variety of courses, such as
New Miner and Annual Refresher, in accordance with 30 CFR Parts
46 and 48. Without the fully funded support that the state
grant provides, the mining community in Oklahoma will be
impacted.
--Pennsylvania: Pennsylvania trains approximately 7,000 miners and
contractors in the Anthracite, Bituminous and Industrial
Minerals mines and facilities of the Commonwealth. This
training is provided at no cost to the mining community by in-
house staff, Pennsylvania State University and Schuylkill Vo-
Tech. We also provide a mine rescue program for small coal and
industrial minerals mines to comply with Federal mine rescue
requirements and required EMT training through Indiana
University of PA at no cost to mine operators. Although a
majority of large operators provide training for their
employees to meet Federal requirements, small mine and facility
operators and contractors rely on the MSHA grant for their
training needs. Pennsylvania also relies on the MSHA grant to
fund other aspects of our mine safety program. These include
staff training, health and safety conferences, mine rescue
contests, safety equipment, mine rescue supplies, and travel
related to these functions.
--Ohio: After reviewing our total surface training numbers for the
year 2012, it would appear that 1,369 trainees would not have
been trained if not for receiving funding from the States Grant
program.
--Colorado: The impact of the elimination of the MSHA training grant
to the miners of Colorado and our training program will be
acute. We trained 5,742 in fiscal year 11 and 4,316 in fiscal
year 12. This includes, coal, metal, non-metal and contractors
who serve the industry. The reduction would be 2,800--3,700
miners not trained, including many that receive training in
Spanish. The reduction would be salaries and operating costs
for two trainers. (The program has 5 FTE total).
--Arkansas: While it is difficult for a service provider to estimate
the total impact on our state from the elimination of grant
funding, we can address how it will impact our ability to
provide the mandatory training to the miners and contractors
who have utilized our services for years. While the Arkansas
MSHA State Training Program has been proactive in trying to
maintain the program and continuing to provide effective
training to those requesting our service, it has become
increasingly difficult to recover the cost for salaries, state
match and travel for the sufficient number of staff needed to
meet the demand, as well as the costs for maintaining training
equipment and supplies. We have already eliminated one part-
time position and raised our training fees, but feel confident
that if we have to raise them again to generate the revenue
needed to sustain the program, it will become a financial
hardship on the small mining operations and contractors who are
our primary clients. At the current rate, without raising fees,
it is likely we would have to eliminate another part-time
position, therefore decreasing our ability to provide the
mandatory training to our clients requesting the service. Also,
grant funds have been used for our staff to attend national and
state MSHA conferences and training events. This would have to
be completely eliminated. The Arkansas MSHA State Training
Program trains an average of 2,000 individual miners and
contractors each year. We have been providing new miner, annual
refresher, and first aid training.
--North Carolina: If State Grant funding is eliminated, we would be
reducing our staff of 6 to a staff of 2 based on our state
appropriations and the fact we would not be awarded any
additional appropriations. I would estimate there would be
6,000 miners we would not be able to provide training for based
on previous number of miners and contractors trained. We
average training at around 8,000 miners per year. This would be
a devastating burden on the small operators who rely on us to
assist them with their safety and health programs. Not only
will they have to pay a significant amount of money for future
training but the quality of training will certainly be a
concern. There are many private instructors who do not provide
effective, quality training. The mining industry is
experiencing the lowest incident rates ever, lowest amount of
accidents, and a record low number of fatalities and we feel
quality, effective training plays a major role with accident
prevention.
--Maryland: The elimination of the MSHA training grant will be the
elimination of the training program in Maryland. Small
operators and contractors will have no training. While the
national and international companies have their own training
programs they still rely on the state to provide training to
contractors and often attend statewide forums sponsored by the
State Program.
--Virginia: Eliminating the MSHA state training funds would
negatively affect the quality of mine safety training in
Virginia and the quantity of assistance the DM and the DMM
provide to small operators and their work force. In particular,
the DM's Small Mine Safety Service (which is dedicated to
assisting the small mine operators) would be adversely
impacted.
Small operators and contractors would be immediately affected
through any reduction in the state's ability to provide mine safety
training. Loss of funding would also impact ongoing training
opportunities for our training staff, and the development of site-
specific training materials, as well as purchase of supplemental
training materials, now being offered to mine operators.
To what extent will the mining in your state be able to ``develop their
own programs or contract these services''? How long do you
anticipate this would take?
--Kentucky: The majority of our mines involve small mines and have no
trainers. The small mines send their employees to our Office of
Mine Safety and Licensing to receive quality training free of
charge. These miners will have to pay a private instructor and
in turn receive inadequate training and in some cases will
receive no training at all. We've seen many problems in the
past with some private instructors not conducting adequate
training and they have been reported to the Federal Mine Safety
and Health Review Commission for sanctions.
--Louisiana: In the absence of our state training program, the mining
industry would have to return to ``fending for themselves'' to
train its miners, resulting in an increased cost to industry
and possibly lower quality of training for individual miners.
--Alaska: The majority of mines in Alaska are small operations with
less than 10 employees that do not have the resources or
capabilities to develop and maintain their own training and
certification systems. It is uncertain how long it may take to
develop programs or contract MSHA training services. At this
point, there are no MSHA training providers other than MAPTS
consistently available for small mines in Alaska.
--Oklahoma: The training OMTI provides serves all of the mining
industry, in particular the smaller mining operations. Without
the training courses offered, the smaller mine sites are most
susceptible to see increased costs and lack of fully trained
miners as required in 30 CFR Parts 46 and 48.
--Pennsylvania: Without the MSHA funding, small operators will have
to either conduct their own training or use training
contractors. Penn State University and Schuylkill Vo-Tech have
established a reputation and trust with the operators with a no
fee option. If the operators wish to continue this arrangement,
a significant cost per student must be absorbed by the
operators. The quality of training provided by the PA Bureau of
Mine Safety, Pennsylvania State University, Schuylkill Vo-Tech
and Indiana University of PA is very high and loss of this
program will have a negative impact on miner safety. It will
also impact Pennsylvania's ability to maintain its world class
mine safety program and ability to support program functions
identified above. One example: Federal law requires all mine
rescue teams to attend at least two competitions each year,
with the states supporting this requirement by holding and
supporting these contests. With state budgets shrinking, the
ability to support these contests without Federal funding is in
jeopardy.
--Ohio: From past experience, the larger mining companies could deal
with developing their own programs and could contract out these
services if needed. The smaller companies and contract miners
would be the ones who either would be left out, or would
struggle with maintaining their training programs. As far as
the time it would take for these companies and contractors to
assume total responsibility for complying with MSHA's training
law standards, it would take a considerable amount of time.
--Colorado: The reduction in support of mine training particularly
affects the medium and small operators who make up 95 percent
of the mining operations in Colorado. This severely reduces the
affect we can all have on preventing accidents and injuries
BEFORE they become a major incident. Unfortunately, this will
leave many operators with few resources for safety and health
and result in an increase in MSHA enforcement inspection time,
citations, and most unfortunately, a likely increase in injury
and accident rates in our state.
--Arkansas: Since the Arkansas MSHA State Training Program places
emphasis on assisting small mining operations and contractors,
we are aware that most of these companies are neither staffed
nor equipped to provide effective training; whereas, the State
Grant staff has multiple years of combined training experience.
Small companies are at a distinct disadvantage in the area of
providing their own training.
--North Carolina: Many small operators will not have the resources to
develop their own programs adequately. Many of them would not
know how to develop lesson plans, outlines, and have the time
or resources to prepare a training program. They would have to
contract their training out to consultants. Mine safety
training was geared to be site-specific and company-specific
which is how we prepare for our classes for mining operations.
Consultants will use a ``canned program'' and there are quality
control concerns with a canned program. We know of operators
who also rely on on-line training and the miners do not like it
because there is no interaction or discussion taking place with
on-line training. In terms of how long it will take for an
operator to implement its own safety and health training
program--probably at least a year or longer.
--Maryland: There is no ability for the small operators, many of whom
don't even know they need the training until the state advises
them, or contractors to provide safety training. Our most
frequent calls are from contractors looking to bid work but who
have limited safety training and generally do not know where to
go to obtain it.
--Virginia: Many larger mining companies already have the
infrastructure to meet these obligations and do. The true
impact of MSHA's decision to eliminate this program will again,
fall on the small operators, who have for years depended on the
Department of Mines, Minerals, and Energy (DMME) to assist them
in meeting their training obligations required by state and
Federal regulations. Most small operators will rely on
contractors to provide the required training. As a consequence
the quality of training may suffer.
--New Mexico: If the New Mexico grants program is not available to
our small businesses in our Part 46 (sand and gravel or
aggregate) industries, the quality of annual refresher and new
miner training would suffer. I believe the alternative will be
that a crusher foreman or pit foreman will be assigned to
provide the training. This individual will likely have little
training experience and even less interest in providing the
training.
What other unanticipated consequences from the elimination of state
grant funding might there be, particularly with respect to
miner safety and health?
--Kentucky: In our opinion the miners will be the ones to suffer
most. They will have to pay for the classes, they will not get
adequate training, and the end result will be an increase in
mine fatalities.
--Louisiana: It strikes us as particularly unfortunate that MSHA
would choose this route of cost savings given that many
fatalities are found to have insufficient training as a root
cause.
--Alaska: Eliminating training funding is expected to lead to an
increase in mining accidents and creates an artificial need for
increased enforcement on mine sites. Reduced MSHA-supported
training will damage the evolution of safety culture
improvements in the mining industry. Focusing solely on
enforcement is likely to further deteriorate individual
attitudes toward MSHA and voluntary compliance with MSHA
requirements.
--New Mexico: The Mine Act of 1977 was very specific in Sections 502
and 503 regarding the requirement to train miners and to fund
state programs to meet the requirements of the Act. We are a
small organization that uses our funding wisely to provide low
cost training services to small business and non-English
speaking miners in our state. We believe this to be an
efficient use of these funds to educate our miners, thereby
providing good paying jobs in a safer environment.
--Pennsylvania: There is no question that cutting the State Grant
Program goes against the intent of Congress, but more important
it will have a negative impact on the health and safety of our
Nation's miners. Every MSHA accident investigation report
highlights the need for quality training to eliminate and
reduce accidents. Not funding the State Grant Program at the
maximum amount ($10,000,000) is misguided and wrong and will
impact our ability to see that all workers go home to their
families at the end of each work shift.
--Ohio: For smaller mines and with the contract miners, their safety
training would suffer, thus causing a potential increase in
mining accidents and serious injuries.
--Colorado: Like other states, we maintain a unique and trusting
relationship with our mine operators and contractors through
regular contact, assistance (such as safety audits, etc.) and
education and training. We can quickly access and update our
mining community regarding the wide range of regulatory
requirements, technological improvements in mine safety and
sharing of mine health and safety resources. The state program
is the gold standard for providing effective and innovative
mine health and safety training and training mine employees and
contractors to effectively train their own employees.
--Arkansas: We believe we will see accidents trend upward. The
training provided by the Arkansas MSHA State Training Program
has proven to have an impact on reduction in accidents; the
statistics reveal that the companies who utilize the State
services for their training needs have fewer accidents than the
companies who have chosen to go another route to obtain their
training. Also, company training might not be comprehensive in
certain areas, such as miners' statutory rights, including the
right to be provided a safe working environment and the right
to refuse to perform unsafe tasks. The State Training program
provides comprehensive training that supports accident
prevention by focusing on eliminating unsafe practices and
conditions that contribute to accidents. State training
reinforces miner knowledge of safe work behavior and encourages
safe work practices, as well as increasing their knowledge in
identifying an unsafe work environment as detailed in the Code
of Federal Regulations. In addition to training, the State
Training staff receives constant e-mails and phone calls
regarding safety and health issues. Many of the companies and/
or individuals the State Grants staff have worked with over the
years are not comfortable going directly to Federal MSHA with
questions or concerns; whereas, the State has developed a
cooperative relationship that has proven mutually beneficial.
--North Carolina: Impacts would include not being available to
provide special emphasis projects such as mock drills, mine
safety and health law seminars, annual mine safety and health
state conferences, explosives safety courses, and not being
able to properly prepare training programs geared to site-
specific needs of mining operations. Training plan assistance
will not be provided. Fatalities, accidents, and incident rates
will be on the rise because of ineffective training.
--Maryland: Impacts would be to lessen the awareness and importance
of safety in day to day work situations. Small operators often
perform multiple tasks and may not take time to think through a
situation such as electrical disconnects on conveyors or repair
of faulty wiring. In addition, the state program goes beyond
MSHA and provides CPR training and warning signs of heat
stroke, fatigue and other health related issues. Also,
individual contractors may not get other safety training as
required at a small operation.
--Virginia: Our most valuable resource, the miner, will be affected
the most due to the lack of effective training. Statistics show
that, without the proper training, the potential for mining
accidents and serious injury does increase significantly. An
increase in unsafe acts and conditions, especially at smaller
mining operations and with independent contractors, could
certainly result in more accidents and injuries to miners and
workers.
The increase in unsafe acts and conditions could also increase
enforcement action by MSHA and the resulting financial burden could
potentially drive many small operators out of business.
--New Mexico: Our number one priority will be to try to continue the
training of our states miners using our State funds. This means
that we will be unable to fulfill certain functions that we
have addressed in the past. These include helping with mine
rescue competitions, completing all of our regulatory
responsibilities and ensuring interaction with operators on
issues such as compliance assistance.
Addendum from Virginia Department of Mines, Minerals and Energy
Our State (Virginia) supports the statement submitted today by the
Interstate Mining Compact Commission, of which we are a member,
concerning the fiscal year 2015 proposed budget for the Mine Safety and
Health Administration (MSHA) which urges Congress to appropriate $10
million for State assistance grants pursuant to Section 503 of the Mine
Safety and Health Act of 1977.
This addendum was submitted by Bradley C. (Butch) Lambert, Deputy
Director, Virginia Department of Mines, Minerals and Energy.
[This statement was submitted by Gregory E. Conrad, Executive
Director, Interstate Mining Compact Commission.]
______
Prepared Statement of the Interstitial Cystitis Association
summary of recommendations for fiscal year 2015
_______________________________________________________________________
--$660,00 for the IC education and Awareness Program at the Centers
for Disease Control and Prevention (CDC).
--$7.8 billion for CDC.
--$32 billion for the National institutes of Health (NIH) and
Proportional Increases Across All Institutes and Centers.
--Support for NIH Research on IC, including the Multidisciplinary
Approach to the Study of Chronic Pelvic Pain (MAPP) Research
Network.
_______________________________________________________________________
Thank you for the opportunity to present the views of the
Interstitial Cystitis Association (ICA) regarding interstitial cystitis
(IC) public awareness and research. ICA was founded in 1984 and is the
only nonprofit organization dedicated to improving the lives of those
affected by IC. The Association provides an important avenue for
advocacy, research, and education. Since its founding, ICA has acted as
a voice for those living with IC, enabling support groups and
empowering patients. ICA advocates for the expansion of the IC
knowledge-base and the development of new treatments. ICA also works to
educate patients, healthcare providers, and the public at large about
IC.
IC is a condition that consists of recurring pelvic pain, pressure,
or discomfort in the bladder and pelvic region. It is often associated
with urinary frequency and urgency. This condition may also be referred
to as painful bladder syndrome (PBS), bladder pain syndrome (BPS), and
chronic pelvic pain (CPP). It is estimated that as many as 12 million
Americans have IC symptoms. Approximately two-thirds of these patients
are women, though this condition does severely impact the lives of as
many as 4 million men. IC has been seen in children and many adults
with IC report having experienced urinary problems during childhood.
However, little is known about IC in children, and information on
statistics, diagnostic tools and treatments specific to children with
IC are limited.
The exact cause of IC is unknown and there are few treatment
options available. There is no diagnostic test for IC and diagnosis is
made only after excluding other urinary/bladder conditions. It is not
uncommon for patients to experience one or more years delay between the
onset of symptoms and a diagnosis of IC. This is exacerbated when
healthcare providers are not properly educated about IC.
The effects of IC are pervasive and insidious, damaging work life,
psychological well-being, personal relationships, and general health.
The impact of IC on quality of life is equally as severe as rheumatoid
arthritis and end-stage renal disease. Health-related quality of life
in women with IC is worse than in women with endometriosis, vulvodynia,
and overactive bladder. IC patients have significantly more sleep
dysfunction, and higher rates of depression, anxiety, and sexual
dysfunction.
Some studies suggest that certain conditions occur more commonly in
people with IC than in the general population. These conditions include
allergies, irritable bowel syndrome, endometriosis, vulvodynia,
fibromyalgia, and migraine headaches. Chronic fatigue syndrome, pelvic
floor dysfunction, and Sjogren's syndrome have also been reported.
ic public awareness and education through cdc
The IC Education and Awareness Program at CDC is critical to
improving public and provider awareness of this devastating disease,
reducing the time to diagnosis for patients, and disseminating
information on pain management and IC treatment options.
The IC program has utilized opportunities with charitable
organizations to leverage funds and maximize public outreach. Such
outreach includes public service announcements in major markets and the
Internet, as well as a billboard campaign along major highways across
the country. The IC program has also made information on IC available
to patients and the public though videos, booklets, publications,
presentations, educational kits, websites, self-management tools,
webinars, blogs, and social media communities such as Facebook,
YouTube, and Twitter. For healthcare providers, this program has
included the development of a continuing medical education module,
targeted mailings, and exhibits at national medical conferences.
The CDC IC Education and Awareness Program also provides patient
support that empowers patients to self-advocate for their care. Many
physicians are hesitant to treat IC patients because of the time it
takes to treat the condition and the lack of answers available.
Further, IC patients may try numerous potential therapies, including
alternative and complementary medicine, before finding an approach that
works for them. For this reason, it is especially critical for the IC
program to provide patients with information about what they can do to
manage this painful condition and lead a normal life.
ICA recommends a specific appropriation of $660,000 in fiscal year
2015 for the CDC IC Education and Awareness Program. ICA also
recommends an appropriation of $7.8 billion for CDC, as well as
continued support for the National Center for Chronic Disease
Prevention and Health Promotion which administers the IC program.
ic research through the national institutes of health
The National Institutes of Health (NIH) maintains a robust research
portfolio on IC with the National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK) serving as the primary Institute for IC
research. Research currently underway holds great promise to improving
our understanding of IC and developing better treatments and a cure.
The NIDDK Multidisciplinary Approach to the Study of Chronic Pelvic
Pain (MAPP) Research Network studies the underlying causes of chronic
urological pain syndromes. The MAPP Study is now in its second phase
and researchers hope to utilize gathered data on patient experiences
with IC to identify different phenotypes of the disease. Phenotype
information will ultimately allow physicians to prescribe treatments
with more specificity. Research on chronic pain that is significant to
the community is also supported by the National Institute of
Neurological Disorders and Stroke (NINDS) as well as the National
Center for Complementary and Alternative Medicine (NCCAM).
Additionally, the NIH investigator-initiated research portfolio
continues to be an important mechanism for IC researchers to create new
avenues for interdisciplinary research.
ICA also supports the National Center for Advancing Translational
Sciences (NCATS), including the Cures Acceleration Network (CAN).
Initiatives like CAN are critical to overhauling the translational
research process and overcoming the research ``valley of death'' that
currently plagues treatment development. In addition, drug
repurposement and other efforts led by NCATS hold the potential to
speed access to new treatment for patients. ICA encourages support for
NCATS and the provision of adequate resources for the Center in fiscal
year 2015.
ICA recommends a funding level of $32 billion for NIH in fiscal
year 2015. ICA also recommends continued support the MAPP Study
administered by NIDDK.
Thank you for the opportunity to present the views of the
interstitial cystitis community.
[This statement was submitted by Lee Claassen, Executive Director,
Interstitial Cystitis Association.]
______
Prepared Statement of the Jamestown S'Klallam Tribe
On behalf of the Jamestown S'Klallam Tribe, I would like to thank
you for this opportunity to submit this written testimony on fiscal
year 2015 Appropriations for the Department of Health and Human
Services. The Federal budget for Tribal health programs and services
should reflect the U.S. Government's commitment to honor and uphold its
Treaty and Trust obligations to American Indians and Alaska Natives.
When Tribal Governments are empowered through Self-Governance with the
flexibility and resources to provide quality healthcare to their
citizens, these investments hold tremendous promise for not only Tribal
communities but for the communities that surround them.
The Jamestown Family Health and Dental Clinics have demonstrated a
real return on the Federal investment and reflect the tremendous
potential Tribes have to not only reduce healthcare costs but to
increase prevention and treatment services for their Tribal citizens.
tribal specific health appropriation priorities
--Restore Sequestered Amounts/Exempt Indian Programs from Budget
Reductions
--Fully Fund Contract Support Costs--Separate Mandatory Appropriation
--Budget Equity for Tribal Governments/Programs Accessible to Small
Tribes
--Medicare/Medicaid Reimbursement
--Provide $30 Million for Part A Grants for Native Americans in the
Older Americans Act--Title VI
--Fund SAMHSA's Behavioral Health Tribal Prevention Grant Program at
$50 million--make sure programs are accessible to small Tribes
national health appropriation priorities
--Definition of Indian
--Fully Fund the Implementation of ACA Inclusive of the IHCIA
--Self-Governance Promotes Efficiency and the Effective Use of
Federal Funds (Title VI of the ISDEAA
regional/national health appropriation priorities
Our Budget Request endorses the requests of The Northwest Portland
Area Indian Health Board, Affiliated Tribes of Northwest Indians, the
Indian Health Service Tribal Self-Governance Advisory Committee and the
National Congress of American Indians and the National Indian Health
Board.
tribal specific priorities
Restore Sequestered Amounts/Exempt Indian Programs from Budget
Reductions
Despite the Federal trust obligation and the well documented and
profound needs of Indian country, Tribal programs were subjected to
sequestration and forced spending reductions. These budgetary
reductions were devastating to our community and will drastically
impede primary healthcare and disease prevention services for our
Tribal citizens for years to come. Tribes should be afforded the same
exemption from funding reductions that are in place for programs
serving our Nations populations with the highest need, such as, Social
Security, Medicaid, Medicare, the Children's Health Insurance Program
and the Veteran's Administration.
Fully Fund Contract Support Costs (CSC) as Required by Law
Adequate Contract Support Cost (CSC) funding assures that Tribes,
under the authority of their Self-Governance compacts, have the
resources necessary to administer and deliver the highest quality
healthcare services to their members without sacrificing program
services and funding. We urge you to consider turning CSC into a
separate mandatory appropriation so that legally enforceable
contractual obligations are not being funded at the expense of
programmatic needs.
Budget Equity for Tribal Governments/Programs Accessible to Small
Tribes
Budget inequity compromises our ability to adequately manage our
health programs and services that we are providing on behalf of the
Federal Government. When Tribes receive an equitable level of
resources, we can address the physical, spiritual and mental well-being
of our Tribal communities in a culturally appropriate manner. There are
often inconsistencies in how formulas are calculated and funding is
distributed for Tribal health programs. In addition, Grant
opportunities often contain criteria and processes that give States and
other interest groups preferential opportunities for awards. Small
Tribes, such as ours, are often further disadvantaged when it comes to
securing these opportunities. It is critical that Tribes receive
equitable resources and equitable access to funding opportunities that
allow Tribes to continue to address Tribally-determined levels of
health and wellness for our communities. Grants provided through the
Administration for Children and Families (ACF) and the Substance Abuse
and Mental Health Services Administration (SAMHSA) are critically
important to our Tribe and we urge you to provide both equitable
funding and opportunities for all Tribes within the confines of these
programs.
Medicare/Medicaid Reimbursement
Federal funding for Medicaid/Medicare expansion is intended to
reduce health disparities in our Tribal communities. Historic and
persistent underfunding of the Indian healthcare system has limited the
ability of Tribes to provide adequate health services that could
prevent or reduce chronic health conditions in Native people. As a
result, American Indians/Alaska Natives have a significantly worse
health status compared to the rest of the Nation.
Because we do not receive full Federal funding to address our unmet
healthcare needs, Jamestown has been forced to use innovative
approaches in order to provide better healthcare services to our Tribal
citizens. Over 50 percent of our healthcare funding is Medicaid and
Medicare and we use the revenue that is generated from these programs
to provide essential health services to our Tribal citizens and their
families. Any changes to the way we receive Medicare and Medicaid
funding would negatively impact our ability to provide basic healthcare
to our Tribal community and the surrounding non-Indian community. Our
innovative approach to providing healthcare services is an effective
and efficient use of the Federal investment. It allows us to leverage
the Federal dollar to provide better health services to more of our
Tribal citizens, reducing future healthcare costs by lessening the need
for expensive chronic and emergency care.
$30 Million--Part A Grants to Native Americans under Title VI of the
Older Americans Act
Programs under Title VI of the Older Americans Act are the primary
funding vehicle for the provision of nutrition and other ancillary
services to our Tribal Elders. Reducing isolation through community and
cultural activities and ensuring our Elders receive proper nutrition
and healthcare is a priority for our Tribe. Without the capacity to
provide support services to our elders, our cultural traditions, and
our language is at risk of being lost.
The Jamestown S'Klallam Elders Meal Delivery Program has been
around for more than 20 years. The Older Americans Act provides much
needed funds to keep this program working for our community. Jamestown
has used Federal funds to prepare and deliver well-balanced nutritional
meals to our Elders that incorporate traditional foods, such as, elk
and fish and use vegetables grown in our community garden. All of our
elders are also given fresh fruit. These services are provided to all
elders of Native heritage, and their spouses, within our service area.
$50 Million--Behavioral Health Tribal Prevention Program
American Indians and Alaska Natives have disproportionately higher
rates of death related to alcohol and substance abuse and suicide. If
funded, the Behavioral Health Tribal Prevention Grant will allow Tribes
to provide behavioral health services that address substance abuse and
suicide prevention and promote overall mental and emotional health. If
funded, this would be the only grant program that is exclusively
available for Tribes.
national health priorities
Definition of Indian
The Administrations current interpretation of ``Indian'' in the
Affordable Care Act (ACA) prevents certain IHS eligible persons from
access to certain healthcare and services available to American Indians
and Alaska Natives under the law. A technical amendment that uses the
Center for Medicare and Medicaid definition of Indian will align the
eligibility regulations and create consistency among all the
Administrative agencies which will provide full access to healthcare
for all American Indians and Alaska Natives.
Fully Fund the Implementation of ACA Inclusive of the IHCIA
The permanent reauthorization of the Indian Health Care Improvement
Act (IHCIA) within the ACA is the most significant advancement in
Federal health policy for Tribes in decades. The purpose of the IHCIA
is to promote healthcare parity for Indian Tribes by addressing
deficiencies in health status and resources within the Indian health
system. Funding for the IHCIA is a top budget priority. Although the
IHCIA provides the authority and, with it, the opportunity to provide
essential healthcare to Tribal citizens, it did not provide the
necessary funds to the IHS to carry out these new statutory
obligations.
There are twenty three unfunded provisions in the Indian Health
Care Improvement Act (IHCIA). Many of the provisions that remain
unfunded would strengthen the Tribal healthcare workforce, provide
greater access to behavioral health and support innovative initiatives
for healthcare delivery to Tribal citizens. Funding these provisions is
a necessary precursor to increase Tribal capacity, infrastructure and
most importantly access to healthcare services. Significant Federal
investment is needed to achieve a fully funded Indian Health Service
and now is the time to act on opportunities made possible in the newly
expanded authorities granted under the Indian Health Care Improvement
Act. Given the unique mission of the IHS as a direct healthcare
provider fulfilling a Federal trust responsibility, fully funding and
implementing the ACA and IHCIA will elevate the health status and
decrease the health disparities experienced by American Indians and
Alaska Natives.
Self-Governance--An Efficient and Effective Use of Federal Funds (Title
VI of the ISDEAA)
Self-Governance is the most successful policy in the history of
Tribal--Federal relations and it inspires efficient and effective
government spending. Through Self-Governance, Tribes are empowered, as
sovereign nations, to exercise self-determination and to design
facilities, manage programs and funds, and provide services that are
responsive to the needs of our communities and Tribal citizens. Tribes
participating in Self-Governance have become successful in the business
of healthcare and perform several key roles, serving as, governments,
employers, healthcare providers and patients.
Self-Governance Tribes have made every attempt to be innovative to
operate successful health programs given the budget constraints and
cuts Tribal programs have incurred the past two decades. For more than
a decade we have made every effort to expand Self-Governance to other
programs and our efforts to seek expansion of the program will continue
until we achieve our goal. We request that this Committee recognizes
the success of Self-Governance and encourage HHS to work with Tribes to
make the most efficient and effective use of Federal appropriations to
fund Tribal programs.
Conclusion
Thank you for the opportunity to provide this important testimony.
We respectfully request that these Budget Priorities be included in the
Appropriations for the fiscal year 2015 Tribal Health Programs Budget.
[This statement was submitted by Hon. W. Ron Allen, Tribal
Chairman/CEO, Jamestown S'Klallam Tribe.]
______
Prepared Statement of Michael Klurfeld
Members of the subcommittee, my name is Michael Klurfeld, and I am
testifying to protect my twin sister, Jessica, and others like her who
require active treatment in campus-based or other settings meeting the
Federal standards for Intermediate Care Facilities for the Mentally
Retarded (``ICF/MR'').\1\
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\1\ In the interest of disclosure, please be aware that I am the
New York State Coordinator for VOR, a national organization that
advocates for high quality care and human rights for people with
intellectual and developmental disabilities. I am submitting this
statement solely on my own behalf, and not as a representative of VOR,
to share my family's story and my personal views with you.
---------------------------------------------------------------------------
Jessica has autism, intellectual disability, and a rare genetic
disorder called Cornelia de Lange Syndrome. Not long after our
thirteenth birthday, Jessica began having severe behavioral challenges,
including physical aggression. For lack of an appropriate residential
school in New York State, our school district sent her to out-of-State
nonpublic residential schools--first in Pennsylvania and then in New
Hampshire. Though her education funding ended, she remains at the New
Hampshire program awaiting repatriation by the New York State Office
for People with Developmental Disabilities to an appropriate adult
residential program in New York.
In Jessica's case, an appropriate placement is a campus-based ICF/
MR--she is legally entitled to this as a Medicaid recipient. As
explained by the Centers for Medicare and Medicaid on the attached page
from their website, ICF/MR is a benefit said to be offered by all
States as an alternative to home and community-based services
(``HCBS'') for individuals at the ICF/MR level of care--individuals in
need of and receiving ``active treatment.'' \2\ ``Active treatment'' is
the key concept here: defined as ``a continuous, aggressive and
consistent implementation of a program of specialized and generic
training, treatment, and health or related services, directed toward
helping the enrollee function with as much self-determination and
independence as possible.'' As CMS points out, ``many ICF/MR residents
work in the community, with supports, or participate in vocational or
other activities outside of the residence, and engage in community
interests of their choice.'' ICF/MR services are provided only in
licensed and certified residential facilities, providing quality
control to protect the residents and financial controls over the
expenditure of public funds--``There are few resources similar to an
ICF/MR under any payment source.''
---------------------------------------------------------------------------
\2\ As CMS notes, Federal law and regulations continue to use the
term ``mentally retarded'' and therefore CMS uses it in this formal
description of these kinds of facilities; CMS otherwise prefers the
term ``individuals with intellectual disability.''
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Although ``States may not limit access to ICF/MR service, or make
it subject to waiting lists, as they may for HCBS,'' in reality access
is drastically limited and, as a practical matter, virtually
unavailable in many States. The States' failure to provide these
mandated services, in violation of the right of Medicaid recipients to
choose ICF/MR over community-based waiver services, has been
erroneously justified with the notion that deinstitutionalization is
required by the Supreme Court's 1999 Olmstead decision--a gross
misstatement of the holding in this important case. Far from requiring
the closing of all institutions, or the denial of legally required ICF/
MR services to those like Jessica who qualify for and require them, the
Supreme Court in Olmstead said that ``each disabled person is entitled
to treatment in the most integrated setting possible for that person--
recognizing on a case-by-case basis, that setting may be an
institution'' [emphasis added].
Ironically, HHS brandishes Olmstead as a tool to force people with
Intellectual and Developmental Disabilities (I/DD) to live in what they
call ``integrated settings,'' often disregarding both the peoples'
needs and choices. In a Kafkaesque fashion, HHS often brings lawsuits
against institutions that it funds--beyond belittling the needs and
choices of people with I/DD, these egregious lawsuits waste Federal
funds because, essentially, HHS is suing itself.
So for the reasons above and for reasons I will explain further, I
ask the Senate to adopt the following language regarding HHS
appropriations:
No funds appropriated for any Department of Health and Human
Services program shall be expended to promote any law or policy that
limits the choices of individuals with intellectual and developmental
disabilities (or, if an individual has a legal representative, the
legal representative), seeking living arrangements they believe are
most suitable to their needs and wishes.
First and foremost, HHS' fallaciously named ``Olmstead
enforcement'' goes against much of what the Supreme Court said in its
ruling while ignoring the circumstances of the case. The plaintiffs in
Olmstead were two women who ``alleged that defendants-petitioners,
Georgia healthcare officials, failed to afford them minimally adequate
care and freedom from undue restraint, in violation of their rights
under the Due Process Clause of the Fourteenth Amendment.''
The Supreme Court found that the women's rights had in fact been
violated, but not solely because they were in an institutional setting:
We emphasize that nothing in the Americans with Disabilities Act or
its implementing regulations condones termination of institutional
settings for persons unable to handle or benefit from community
settings . . . Nor is there any Federal requirement that community-
based treatment be imposed on patients who do not desire it.''
HHS seems to have largely ignored this language, for if they
hadn't, Olmstead enforcement would be entirely different. Olmstead
enforcement, properly implemented, would be limited to helping people
like the plaintiffs in that case who were institutionalized against
their wills without due process. But instead, HHS spends taxpayer money
in attempts to shut down the facilities to which my sister and people
like her are legally entitled under the law, which they have chosen (as
is their right), and which HHS itself funds. Nothing in Olmstead
requires--or even authorizes--HHS to deprive Medicaid recipients with
I/DD from choosing to receive the ``active treatment'' to which they
are entitled in the ``institutional'' setting of an ICF/MR, and HHS
should not be allowed to appropriate funds in its efforts to deny these
recipients their choice.
And that's really the crux of the issue: HHS appropriation of funds
in support of deinstitutionalization activities belittles and
disregards my sister's choice of living situation. My sister and people
like her, whether by their own choice or through their legal guardians
(in Jessica's case my mother), are entitled to live in the setting they
choose and that best meets their needs. HHS would never try to prohibit
a group of non-disabled people from living on a campus together. My
sister's disability should not change this.
If HHS is allowed to continue its campaign, it will continue to
threaten both my sister's right to the treatment to which she is
legally entitled, as well as her access to a living situation which she
chooses and which meets her needs. In a world where HHS completes its
``Olmstead enforcement,'' there will be no more campus-based settings,
and Jessica will have to live in a group home where she may nominally
be ``in the community'' but not a part of it in any meaningful sense.
Because she becomes anxious when in close proximity to others, she
would isolate herself in her bedroom and rarely venture out. Because of
her aggressive behaviors, any interactions with neighbors or others
outside the group home setting would be rare to nonexistent. Her life
would be that of Mrs. Rochester from Jane Eyre, which is no life at
all.
Thank you for your time and consideration in this manner.
The below text comes from CMS' website:
Intermediate Care Facilities for Individuals with Mental Retardation
(ICF/MR)
Intermediate Care Facilities for individuals with Mental
Retardation (ICF/MR) is an optional Medicaid benefit that enables
States to provide comprehensive and individualized healthcare and
rehabilitation services to individuals to promote their functional
status and independence. Although it is an optional benefit, all States
offer it, if only as an alternative to home and community-based
services waivers for individuals at the ICF/MR level of care.
IMPORTANT NOTE: Federal law and regulations use the term
``intermediate care facilities for the mentally retarded''. CMS prefers
to use the accepted term ``individuals with intellectual disability''
(ID) instead of ``mental retardation.'' However, as ICF/MR is the
abbreviation currently used in all Federal requirements, that acronym
will be used here.
Eligibility for ICF/MR Benefit
ICF/MR is available only for individuals in need of, and receiving,
active treatment (AT) services. AT refers to aggressive, consistent
implementation of a program of specialized and generic training,
treatment and health services. AT does not include services to maintain
generally independent clients who are able to function with little
supervision and who do not require a continuous program of habilitation
services. States may not limit access to ICF/MR service, or make it
subject to waiting lists, as they may for HCBS. Therefore in some cases
ICF/MR services may be more immediately available than other long term
care options. Many individuals who require this level of service have
already established disability status and Medicaid eligibility.
State Variation
Need for ICF/MR is specifically defined by States, all of whom have
established ICF/MR level of care criteria. State level of care
requirements must provide access to individuals who meet the coverage
criteria defined in Federal law and regulation. In addition to level of
care for AT, the need for AT must arise from ID or a related condition.
The definition of related condition is primarily functional, rather
than diagnostic, but the underlying cause must have been manifested
before age 22 and be likely to continue indefinitely. States vary in
practical application of the concept of related condition. In some
States individuals applying for ICF/MR residence may be eligible for
Medicaid under higher eligibility limits used for residents of an
institution.
Services Included in the ICF/MR Benefit
ICFs/MR provides active treatment (AT), a continuous, aggressive,
and consistent implementation of a program of specialized and generic
training, treatment, and health or related services, directed toward
helping the enrollee function with as much self-determination and
independence as possible. ICF/MR is the most comprehensive benefit in
Medicaid.
Federal rules provide for a wide scope of required services and
facility requirements for administering services. All services
including healthcare services and nutrition are part of the AT, which
is based on an evaluation and individualized program plan (IPP) by an
interdisciplinary team. Facility requirements include staffing,
governing body and management, client protections, client behavior and
physical environment, which are specified in the survey and
certification process.
Day Programs
Many ICF/MR residents work in the community, with supports, or
participate in vocational or other activities outside of the residence,
and engage in community interests of their choice. These activities are
collectively often referred to as day programs. The ICF/MR is
responsible for all activities, including day programs, because the
concept of AT is that all aspects of support and service to the
individual are coordinated towards specific individualized goals in the
IPP.
Where ICF/MR Services are Provided
Medicaid coverage of ICF/MR services is available only in a
residential facility licensed and certified by the State survey agency
as an ICF/MR. Medicaid ICF/MR services are available only when other
payment options are unavailable and the individual is eligible for
Medicaid. There are few resources similar to an ICF/MR, under any
payment source.
______
Prepared Statement of the KNI Parent Guardian Group
Dear Senate Appropriations Sub-committee, thank you for the
opportunity to provide testimony. It is with a heavy heart that I
submit outside witness testimony today, respectfully requesting your
full consideration of the effects of pervasive Intermediate Care
Facility (institutional--ICF/ID) closure activities.
Numerous federally funded agencies under the Department of Health
and Human Services (HHS) are pursuing an idealistic agenda that puts
the weakest members of our society into harm's way, while ignoring
significant deficiencies in the home and community based service system
(HCBS).
I am calling on this Sub-committee to PROHIBIT the use of Federal
HHS appropriations supporting deinstitutionalization activities which
evict without cause, and without regard to individual choice, people
with the most profound intellectual and developmental disabilities (I/
DD) from HHS-licensed ICF homes.
community deficiencies
--Stagnant Direct Support Staff wages, high turnover rates, staff
rationing, and inadequate professional oversight of scattered
homes are affecting quality of care for those served in HCBS
waiver systems. The most helpless on the disability spectrum
are particularly affected by these systemic deficiencies.
--Diminishing incentive to retain quality staff is reflected in the
pervasive, stagnant wage crisis, while re-imbursement rates
have not changed significantly for over a decade. As a result,
the profoundly disabled often do not get to choose who cares
for them, even if they somehow could indicate with whom they
would like to live. This reality flies in the face of
idealism--pushing ``community for all.''
--There is no adequate system in place which represents persons
adjudicated incompetent, who have no or extremely limited self-
advocacy skills, particularly to express abusive acts committed
against them in poorly supervised community homes with rationed
staff and limited professional oversight.
As the Guardian of a profoundly disabled young man, I have
navigated and utilized a broad array of community services for over 15
years. My final recourse after exhausting every option, was to place my
loved one at the Kansas Neurological Institute (KNI), because no one in
the HCBS system was able to handle him.
Since his placement at KNI our grandson has been very well cared
for, being restored to a place of stability unparalleled in the
community. We have tried without success, to reintegrate him into
community as unfortunately, more than a a few community providers have
refused to serve him.
Facilities like KNI are the safety net for those whom the community
is not suitable or has failed to keep safe, yet these havens are under
attack nation-wide. A number of HHS funded programs are displacing our
most vulnerable without regard to clarifications in the Supreme Court
Olmstead ruling, which highlights individual choice, need and safety.
Groups including the ARC, National Council on Disabilities, State
DD Councils, Universities for Excellence, and State Protection &
Advocacy have ignored mounting evidence of abhorrent community outcomes
for the most helpless within the disability spectrum. These federally
funded entities appear to collaborate and push the extreme agenda of
forced closure of all State ``institutions''. This radical agenda fails
to recognize community capacity issues and an increasing number of
documented tragedies occurring within the community system.
Why are these agencies pushing to close facilities where
compassionate staff care for our weakest, forcing our most vulnerable
into questionable environments?
How is ``justice'' served when the most helpless are placed in
community settings, suffering neglect and death after a few months time
at the hands of poorly trained staff who have little or no professional
oversight?
``Is it ever right to handcuff and over-medicate someone with
disabilities, just so you can `handle' them?'' This question was
presented to the National Council on Disabilities in December by a
guardian whose brother had been de-institutionalized, and subsequently
bounced around to unsuccessful community placements.
HCBS tragedies are happening to such a degree that your colleague,
Senator Chris Murphy has called for a nation-wide
investigation.
Parents and guardians are speaking out for those who cannot speak
for themselves, many of whom had experienced failed community
placements, yet these parents are vilified as obstacles to ``systems
change.''
Do current HCBS deficiencies and tragic outcomes for the weakest
reflect sound policy?
There is a compelling need for both community-based and congregate
care settings. States need to operate a range of services to meet the
diverse requirements of persons with disabilities as clarified within
the Supreme Court Olmstead ruling:
olmstead
``We emphasize that nothing in the ADA or its implementing
regulations condones termination of institutional settings for persons
unable to handle or benefit from community settings...Nor is there any
Federal requirement that community-based treatment be imposed on
patients who do not desire it.'' Id. at 601-602.
A plurality of Justices noted:
``[N]o placement outside the institution may ever be appropriate .
. . `Some individuals, whether mentally retarded or mentally ill, are
not prepared at particular times-perhaps in the short run, perhaps in
the long run-for the risks and exposure of the less protective
environment of community settings' for these persons, `institutional
settings are needed and must remain available''' (quoting Amicus Curiae
Brief for the American Psychiatric Association, et al).
Justice Kennedy noted in his concurring opinion, ``It would be
unreasonable, it would be a tragic event, then, were the Americans with
Disabilities Act of 1990 (ADA) to be interpreted so that States had
some incentive, for fear of litigation to drive those in need of
medical care and treatment out of appropriate care and into settings
with too little assistance and supervision.'' Id. at 610.
The real civil rights issue is the disregard for those who have
been forced from safe environments by pervasive deinstitutionalization,
without addressing the mounting capacity issues. As a Nation, we have
neglected to ensure supports necessary for success, including
adequately paid support staff and solid accountability parameters,
while pursuing an over-reaching push of ``Community for all.''
Until the community Direct Support Staff wage issue is honestly
solved, the deficient abuse reporting system remedied, and systemic
assurances providing adequate oversight for the most defenseless living
in scattered homes across our States, we have no true, successful
inclusion for the profoundly disabled who cannot speak or defend
themselves.
On behalf of ``the least of these,'' our most vulnerable, I provide
comment today, and ask the Committee to take compassionate actions on
their behalf.
[This statement was submitted by Joan Kelley, Legal Guardian; Vice-
president, KNI Parent Guardian Group.]
______
Prepared Statement of Susan G. Komen
On behalf of Susan G. Komen, I appreciate the opportunity to
submit written testimony regarding the need for increased Federal
funding for breast cancer early detection programs and cancer research.
Specifically, we call on you to increase funding for the National
Breast and Cervical Cancer Early Detection Program (NBCCEDP), funded
through the Centers for Disease Control and Prevention (CDC), to $275
million and for the National Institutes of Health (NIH) to $32 billion
in fiscal year 2015, including $5.26 billion for the National Cancer
Institute (NCI).
Komen is the world's largest grassroots network of breast cancer
survivors and advocates fighting to save lives, empower people, ensure
quality care for all, and energize science to find the cures. With our
network of local Affiliates across the U.S. and the 2.9 million breast
cancer survivors we represent, we have long considered ourselves key
partners with the Federal Government in the fight against breast
cancer. Since 1983, we have invested more than $2.5 billion for breast
cancer research and life-saving community programs across the country.
While I recognize the difficult task in balancing competing budget
priorities in the current fiscal climate, the only way to eradicate
breast cancer is through a renewed investment and commitment to
discovering and delivering the cures and improved access to affordable,
quality and timely breast health screening and treatment services.
National Breast and Cervical Cancer Early Detection Program
We call on Congress to increase funding for the National Breast and
Cervical Cancer Early Detection Program (NBCCEDP), funded through the
Centers for Disease Control and Prevention (CDC), to $275 million in
fiscal year 2015.
NBCCEDP is a State-Federal partnership that provides lifesaving,
free or low-cost breast and cervical cancer screenings, diagnostic
services, and follow-up services to low-income, uninsured and
underinsured women who do not qualify for Medicaid. Since its inception
in 1991, NBCCEDP has provided over 11 million screening exams to more
than 4.5 million women, detecting more than 62,000 breast cancers,
3,400 cervical cancers and 163,000 premalignant cervical lesions.\1\
Despite the critical services this program provides, at current funding
levels, NBCCEDP can still only serve less than one-fifth to one-third
of those who are projected to be eligible after the implementation of
health reform for the program.\2\
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\1\ Centers for Disease Control and Prevention, http://www.cdc.gov/
cancer/nbccedp/about.htm, accessed 5/21/14.
\2\ Levy AR, Bruen BK, Ku L. Health Care Reform and Women's
Insurance Coverage for Breast and Cervical Cancer Screening. Prev
Chronic Dis 2012;9:120069.
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While the Affordable Care Act increases access to mammography
coverage for many women, it is estimated that, in 2014, 4.5 million
women will remain uninsured and eligible for the program.\3\ This
assumes that all States will implement all the provisions of the ACA
and expands Medicaid. For these women, NBCCEDP continues to fill a
critical gap in the healthcare delivery system, providing access to
annual breast and cervical cancer screenings that can lead to easy
detection and effective treatment for breast cancer.\4\ Without
NBCCEDP, many uninsured women could be forced to delay or forego
screenings, leading to later stage diagnoses, which are deadlier and
more costly to treat. In fact, breast cancer can be up to five times
more expensive to treat when it has spread to other parts of the
body.\5\
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\3\ Levy AR, Bruen BK, Ku L. Health Care Reform and Women's
Insurance Coverage for Breast and Cervical Cancer Screening. Prev
Chronic Dis 2012;9:120069.
\4\ ACS Cancer Prevention and Early Detection Facts and Figures
2013-http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/
documents/document/acspc-037535.pdf.
\5\ Cost of Breast Cancer Treatment in Medicaid- Med Care. 2011
Jan;49(1):89-95. doi: 10.1097/MLR.0b013e3181f81c32.
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Many women with health insurance still face substantial barriers to
obtaining health services, including of lack of health literacy,
geographic isolation and limited language proficiency. Among these
harder to reach populations, NBCCEDP fills a critical gap by providing
outreach and navigation services, which can improve healthcare access
and increase breast cancer screening rates.\6\
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\6\ Levy AR, Bruen BK, Ku L. Health Care Reform and Women's
Insurance Coverage for Breast and Cervical Cancer Screening. Prev
Chronic Dis 2012;9:120069.
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It is clear that there will still be unmet need; millions of low-
income and uninsured women will still lack access to services. We
believe the CDC can build on the 20+ year investments made through the
NBCCEDP and leverage the extensive capacity and infrastructure the
program has built with the clinical care system to increase screening
on a population level.
CDC can also work with various healthcare systems (FQHCs, Medicaid,
provider networks, etc.), to increase widespread participation in
screening by expanding key public health roles such as public education
and outreach; provision of screening services and care coordination;
quality assurance, surveillance and monitoring; and strategies to
enable more organized systems of care.
In 2014, CDC would like to begin transitioning the program by
enabling grantees to expand public health roles that can increase
population level screening rates, while still being able to provide
limited screening services to the most vulnerable.
Increasing current funding levels is critical to ensure that the
CDC can raise awareness, provide lifesaving cancer screenings to women,
and continue to reach those who will remain vulnerable and without
access.
National Institutes of Health
We urge you to increase funding for the National Institutes of
Health (NIH) to $32 billion in fiscal year 2015, including $5.26
billion for the National Cancer Institute (NCI), in order to restore
funding to inflation-adjusted, pre-sequestration levels.
Cancer is an expensive disease--the most costly to our Nation in
terms of direct medical costs and lost productivity due to premature
deaths and disability--making research which will accelerate cures and
improve treatment a sound investment. Federal funding must keep pace
with biomedical inflation as we stand on the threshold of life-saving
discoveries in the biomedical sciences.
This investment in research will not only protect Americans against
disease and illness, but will serve as one of our Nation's primary
paths to innovation, global competitiveness, and economic growth. As
other nations aggressively invest in research and development, the U.S.
is losing ground. We stand to lose the young scientists, high quality
jobs, industries and private-sector capital that have made America a
global leader.\7\ Studies show each dollar in NIH funding generates
more than twice as much in new business activity, and NIH grants and
contracts created and supported more than 400,000 jobs across the
country in 2013.
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\7\ Research!America (www.researchamerica.org).
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Our Nation's investment in biomedical research has helped drive
progress against cancer, furthered our understanding of disease
mechanisms and spurred the translation of scientific discoveries into
new and better ways to prevent, detect, diagnose, and treat cancer. It
is important to highlight some of the important advances, which have
revolutionized the way in which breast cancer patients are screened,
diagnosed and treated. These investments have also positively impacted
survival rates beyond 5 years.
It is now established that routine mammographic screening is an
accepted standard for the early detection of breast cancer. The results
of eight randomized trials, the NIH-ACS Breast Cancer Detection
Demonstration Projects, and other research studies showed that
mammographic screening can reduce the mortality from breast cancer. In
the treatment of breast cancer, lumpectomy followed by local radiation
has replaced mastectomy as the preferred surgical approach for treating
early-stage breast cancer. The approaches to treatment, by learning
critical differences among the types of breast cancer, with
chemotherapy and hormonal therapies have allowed patients different
options and more personalized treatment plans. Tamoxifen and another
SERM, raloxifene, have been approved by the FDA as treatments to reduce
the risk of breast cancer in women who have an increased risk of
developing the disease.\8\
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\8\ National Cancer Institute (www.cancer.gov/cancertopics/
factsheet/cancer-advances-in-focus/breast).
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Finally, several breast cancer susceptibility genes have now been
identified, including BRCA1, BRCA2, TP53, and PTEN/MMAC1. Approximately
60 percent of women with an inherited mutation in BRCA1 or BRCA2 will
develop breast cancer sometime during their lives, compared with about
12 percent of women in the general population. Women with inherited
BRCA1 or BRCA2 gene mutations also have an increased risk of ovarian
cancer.\9\ This knowledge can help patients make more informed
decisions about their risks and potential treatment options. We are
poised to apply this new knowledge to make significant strides in
saving lives.
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\9\ National Cancer Institute (www.cancer.gov/cancertopics/
factsheet/cancer-advances-in-focus/breast).
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As a Nation, we are facing a crisis in cancer care. As the
population ages, the number of new cancer cases in the United States is
projected to increase by as much as 42 percent, 2.3 million new cases
annually, by 2025.\10\
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\10\ AACR Cancer Progress Report 2013 (http://
cancerprogressreport.org/2013/Documents/2013_AACR_CPR_FINAL.pdf).
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Despite these staggering statistics, cancer research funding at the
NCI as a share of the NIH budget has declined. In the late 1990s, NCI's
budget made up nearly 19 percent of the NIH budget. Today, NCI accounts
for approximately 16 percent. In real dollars, this decline means that
NCI's funding has been reduced by $680 million below what it would have
received in fiscal year 2014 if its share of NIH's total budget had
been maintained.\11\ It is imperative that our Nation's investment in
cancer research remains a priority, and that funding for NIH increases.
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\11\ One Voice Against Cancer (www.ovaconline.org).
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On behalf of the many Americans who are suffering with cancer, I
ask that you consider our requests for increased support for the
NBCCEDP and the NIH in fiscal year 2015. Susan G. Komen stands ready to
serve as a national resource for Congress and for all Americans on
breast health issues.
[This statement was submitted by Judith A. Salerno, MD, MS,
President and Chief Executive Officer, Susan G. Komen.]
______
Prepared Statement of the Lenders Coalition for Community Health
Centers
The Lenders Coalition for Community Health Centers (LCCHC) is
pleased to provide the following written testimony related to proposed
fiscal year 2015 HRSA funding for federally Qualified Health Centers
(FQHCs) funded under Section 330 of the Public Health Services Act.
This testimony includes recommendations to assist the Administration
and Congress in developing policies that will help meet a near
universal goal--expanding community health centers in an affordable and
sustainable manner to meet the healthcare needs of millions of families
in underserved communities throughout the United States.
LCCHC is a coalition of community development financial
institutions (CDFIs) and related entities whose main goal is to
advocate for resources and policies that will strengthen health
centers' access to capital and CDFIs' ability to finance health center
growth. The CDFIs that form the LCCHC are all currently undertaking
health center lending. They have made loans totaling more than $1.4
billion to develop primary care capacity that gives more than 3 million
patients access to primary care every year.
The LCCHC has been on record in support of increased--and
continued--operational funding support for health centers. Our
institutions sent a letter to the President advocating the full
operational increase in mandatory funds from the Health Centers Fund in
fiscal year 2015, and underscored the need to sustain and grow that
investment over the next 5 years to ensure the financial stability of
our client FQHCs moving forward.
We note that the President's fiscal year 2015 budget proposes
utilizing $800 million in health center funding for one-time capital
grants. We believe that to the extent any new funding for capital
projects is included in this year's final appropriation, HHS should
encourage awardees to use these scarce dollars to leverage other
sources of capital--both grants and loans from the public and private
sector--to maximize their impact on health center growth. Given that
$800 million represents less than 10 percent of the estimated $10
billion of capital funding that will be needed in order to meet the
goal of serving 35 million patients in FQHCs by the end of 2018,
developing policies that promote the availability of multiple public
and private sources of capital will be critical to health centers'
successful growth. By incorporating incentives to encourage leveraging
into the HHS review process of any potential capital grant funding for
those FQHCs that can raise other sources of capital and/or afford to
take on some reasonable amount of debt, HHS will be able to support a
much larger number of FQHCs around the country.
We also recognize that capital from the Health Centers Fund--even
if it is leveraged--is not a complete solution to address the capital
needs of FQHCs. We strongly encourage the consideration of robust
Federal credit enhancement programs targeting FQHCs expansion, which
would leverage much greater levels of private sector financing for
FQHCs.. Programs such as these are available and have been used to
considerable success for a number of vital sectors, including small
businesses (SBA), rural and agricultural enterprises (USDA), charter
schools (ED) housing and hospitals (HUD).
We wish to be clear that we reject policies encouraging FQHCs to
pursue leverage irresponsibly. Over-leverage is a real risk in any
sector; where it involves the development of critical health
infrastructure and the use of public funds, it simply must be
prevented. Indeed, as community lenders, our mission is aligned with
our borrowers, and we have a stake in their sustainability and success.
Attached, please find a brief that highlights the benefits of
leveraging HHS capital dollars. The arguments in this brief assume that
FQHCs work with responsible lenders, develop financially and
operationally sustainable expansion projects, and assume a level of
debt that supports their expansion without negatively impacting their
current operations or financial stability. Based on our collective
experience in the FQHC sector itself, as well as across a broad range
of other capital needs within low income communities (e.g., affordable
housing, healthy food financing, and school financing), we are
confident that the Administration and Congress can maintain policies
that enable these conditions.
why leveraging of hrsa capital grants is essential to the future of
federally qualified health centers (fqhcs)
HRSA has set, and the health center field has embraced, the goal of
expanding health centers to meet the stated goal of serving 35 million
patients by the end of 2018 (from approximately 22 million today).
Based on an estimate from Capital Link, more than $10 billion in
additional capital will need to flow into FQHC facility development and
expansion to meet this target.
If public funding alone will not suffice to meet the FQHC field's
collective expansion goal, the only feasible alternative is instead to
ensure that limited public funds be deployed strategically to bring
private sector capital to bear. Such an approach can stretch scarce
Federal resources, attract more lenders into the market, lower
borrowing costs, and incentivize FQHCs to develop projects with greater
impact on patients than would be possible otherwise.
The Lack of a Clear, Unambiguous Signal that Leverage is Integral to
HRSA's Future Plans for FQHCs Causes Inefficiencies in FQHC
Financing to Persist
Capital Grant Funding Rounds that Fail to Incentivize Leverage
Disrupt the Existing FQHC Pipeline and Distort Project Sizing.--Today,
FQHCs often work with CDFIs and other lenders across the country to
generate a pipeline with hundreds of viable FQHC expansion projects in
varying stages of development. When HRSA announces a capital grant
round (or even the possibility of a capital grant round) that holds out
the promise of a one-stop, debt-free financing strategy, that pipeline
largely freezes, as FQHCs understandably put development plans on hold
in the hope of avoiding the need to borrow money at all.
Unfortunately, that hope is often in vain, given the reality that
demand far outstrips the funding available, leading to lengthy grant
application and review processes and many unfunded projects.
Additionally, FQHCs size their projects to the HRSA grant maximum
rather than to the size that best serves the healthcare needs of the
community and that CDFIs or other responsible lenders will underwrite.
The result is delays or cancellation of FQHC expansion projects that
could have served hundreds of thousands of patients.
Thoughtful Incentives to Promote Leverage would Enable HRSA to Magnify
the Impact of its Capital Grants and Supplement its Own
Oversight of FQHCs with Private Sector Underwriting
Leverage is a `Force Multiplier' for Limited HRSA Capital Grants.--
Simply put, a given level of Federal operating and capital funding can
yield dramatically increased FQHC expansion if it unlocks access to
private sector capital. When FQHCs are required to supplement Federal
grant funding with outside capital, they are more likely to develop
projects that are scaled to the needs of the community rather than to
the size of the grant award, offering the opportunity for greater
impact on the community's health.
To offer an instructive experience in another sector, in fiscal
year 2014, Congress enacted the Administration's Rental Assistance
Demonstration (RAD), providing public housing authorities new
flexibilities to leverage their annual public housing operating and
capital grants from the Department of Housing and Urban Development
(HUD) to rehab or redevelop up to 60,000 units of public housing.
Notably, no `new' money was appropriated--i.e., the operating and
capital fund allocations that the local agencies received remained the
same (well below their annual operating costs and accumulated capital
backlog). To date, applications submitted to HUD under this `no cost'
leveraging strategy have proposed to bring to bear in excess of $6
billion in private and other public sector capital to the rehab and
redevelopment of public housing units previously assisted exclusively
by Federal funds.
If Congress appropriates capital funding for health centers in
fiscal year 2015, HRSA should draw from the experience of the
affordable housing field, and other sectors, in the effort to deploy
leverage strategically in service of health center capital expansion
goals. Health centers have, for the moment, the further good fortune of
being `ahead of the curve,' relative to the field's funding levels and
capital needs (the public housing field, for example, embraced policy
reforms like RAD only after years of underfunding and a capital backlog
in excess of $27 billion).
Leverage Leads to Superior `Front End' Underwriting and Faster
Project Development.--When an FQHC uses debt financing for a project,
the project goes through a rigorous review by the lender (or lenders)
as part of the underwriting process, creating a higher likelihood for
successful development of the project. Scrutiny of the experience and
capacity of the project's development team ensures that the right
pieces are in place for construction that is on time and within budget.
Furthermore, the lenders' scrutiny of underlying financials and
staffing plans and testing of revenue projections can lead to an FQHC
making constructive modifications to its plans. To be clear, this is
not a substitute for the conscientious and diligent oversight conducted
by HRSA staff on behalf of the taxpayer, but rather a useful supplement
to their efforts by project development experts whose livelihood
depends on having their loans paid back.
Leverage Builds in `Early Warning' Systems that Prevent FQHC
Project Failure.--Experience across capital financing sectors,
including affordable housing (e.g., three decades of experience with
the Low Income Housing Tax Credit), has demonstrated that private
sector oversight of project operations is a useful supplement to the
scrutiny of dedicated, competent but often overextended public
servants, Lenders, as part of their loan servicing and monitoring, keep
a monthly watch on every borrower, enabling them to see financial
problems early on, before they have grown more expensive and difficult
to fix. When lenders provide financing to FQHCs, they are responsible
for ensuring regular loan repayments. Borrowers are required to submit
regular financial statements showing cash flow, accounts payables and
receivables, and other indicators of financial health. If the borrower
misses loan payments or shows other signs of financial distress, a CDFI
can work with borrowers to develop solutions that will bring a health
center back to financial stability. When necessary, this assistance may
involve working with other stakeholders, including foundations, State
Medicaid agencies, or HRSA to make sure a community is not deprived of
vital primary care capacity.
Leverage Creates Financial, Community and Political Partners in
Ensuring Health Center Sustainability.--Critically, the involvement of
other stakeholders in FQHC health--from philanthropy to CDFIs to banks
and private sector investors--is not limited to the all-hands-on-deck
project workouts described above. When FQHCs are required to assemble
matching or contributing funds for a project, they seek funding
assistance from a range of other public and private sources, including
grants and loans. The act of assembling these funds generates community
``buy-in'' and support for a proposed project, which ultimately
contributes to its success by aligning community priorities and
resources toward a common end.
Indeed, the broadening of the constituency of stakeholders with
`skin in the game' when it comes to both individual FQHCs and the field
more broadly, is essential to FQHCs' long-term sustainability: it
creates a bulwark against appropriations risk while simultaneously
helping to ensure that FQHCs remain viable and competitive in the
rapidly evolving field of primary care provision to low income
neighborhoods and populations.
______
Prepared Statement of the Local Initiatives Support Corporation
Chairman Harkin, Ranking Member Moran, and Distinguished Members of
the Senate Appropriations Subcommittee on Labor, Health and Human
Services, Education and Related Agencies: Thank you for the opportunity
to offer written testimony on the Administration's fiscal year 2015
Budget Request for the Department of Health and Human Services,
Administration for Children and Families. The Local Initiatives Support
Corporation (LISC) views this hearing as a positive step toward
understanding the importance of early childhood development and
securing critically needed investments to ensure that all children,
especially low-income children, are given a strong start and enter
kindergarten ready to learn. As you consider ways that Congress can
help children get an early start on the pathway to success, we
encourage you to recognize the critical role that early childhood
facilities play in preparing young children for achievement in school
and in life, and urge you to ensure that Federal policies adequately
finance the acquisition, construction, and improvement of these spaces.
about lisc
Established in 1979, the Local Initiatives Support Corporation
(LISC) is a national nonprofit with Community Development Financial
Institution (CDFI) designation, dedicated to helping community
residents transform distressed neighborhoods into healthy places of
choice and opportunity--good places to work, do business and raise
children. LISC mobilizes corporate, government and philanthropic
support to provide local community development organizations with
loans, grants and equity investments; local, statewide and national
policy support; and technical and management assistance.
LISC has local offices in 30 cities and partners with more than 50
organizations serving rural communities throughout the country. We
focus our activities across five strategic community revitalization
goals:
--Expanding Investment in Housing and Other Real Estate
--Increasing Family Income and Wealth
--Stimulating Economic Development
--Improving Access to Quality Education, and
--Supporting Healthy Environments and Lifestyles.
For more than three decades, LISC has developed programs and raised
investment capital to help local groups revive their neighborhoods.
Because we recognize the link between human opportunity and social and
economic vitality, we have spent the last 17 years working to bring
high quality early care and education settings to low-income
neighborhoods where children enter the world at high risk for negative
outcomes. Through our signature early childhood program, the Community
Investment Collaborative for Kids (CICK), LISC has invested $48 million
in planning and developing 184 new facilities serving 20,000 children
in more than 65 low-income urban and rural neighborhoods across the
country.
overview
Early childhood is a critical development period. Research shows
that a complex interplay between genetics and environment profoundly
influences how children grow physically, socially, and emotionally.
Investments in high quality early childhood programs can help promote
healthy development and strong communities. Those active in community
revitalization believe without question, that early care and education
programs are essential parts of every neighborhood--they prepare young
children for success in school and life, support working parents, and
improve family well-being.
Regrettably, many families--particularly those who are low-income
or in rural areas--lack access to the stable, high-quality early
childhood centers that parents need to maintain gainful employment and
children need to grow and thrive. Additionally, while there is
appropriate focus on the need for high quality curriculum and qualified
teachers, the physical environment is an essential feature that is
often forgotten.
In this testimony, we highlight the important role that physical
environments play in supporting the quality of early learning programs
and healthy early childhood development and encourage Congress to
address the need for comprehensive early childhood facility policies.
background
Early Childhood is a Critical Development Period
Decades of research has shown that early life experiences are
extremely important to the social, emotional, and academic development
of children.\1\ Positive experiences promote healthy brain development
and behavior, while negative experiences undermine development--and, in
severe circumstances, permanently impair a child's nervous and immune
system, stunting healthy growth.\2\ High quality early care and
education is widely regarded as the single most effective intervention
to promote healthy development and close the academic achievement gap
for low-income children at-risk for poor social and economic
outcomes.\3\ The data are clear: the quality of one's early childhood
experiences profoundly influence that person's future life trajectory.
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\1\ Jack P. Shonkoff and Deborah A. Phillips, Editors, From Neurons
to Neighborhoods: The Science of Early Childhood Development, National
Research Council Institute of Medicine, National Academy Press,
Washington, DC 20000
\2\ National Scientific Council on the Developing Child.
``Excessive Stress Disrupts the Architecture of the Developing Brain.
Working Paper No. 3'' (2005) http://www.developingchild.net/pubs/wp/
Stress_Disrupts_Architecture_Developing_Brain.pdf. (Accessed June 17,
2009).
\3\ http://www.readynation.org/uploads//
20130919_ReadyNationVitalLinksLowResEndnotes.pdf, Schweinhart, L. J.,
Montie, J., Xiang, Z., Barnett, W. S., Belfield, C. R., & Nores, M.
(2005). Lifetime Effects: The High/Scope Perry Preschool Study Through
Age 40. Ypsilanti, MI: High/Scope Press. And Reynolds, A. J., Temple,
J. A., Robertson, D. L., & Mann, E. A. (2002). Age 21 Cost-Benefit
Analysis of the Title I Chicago Child-Parent Centers. Madison, WI:
Institute for Research on Poverty. And FPG Child Development Center.
(1999). Early Learning, Later Success: The Abecedarian Study. Chapel
Hill, NC: University of North Carolina.
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The Quality of Early Childhood Facilities Matters
While many factors contribute to program quality, the physical
environment is an essential feature that is often overlooked. The link
between the quality of buildings and the quality of programs tends to
be only vaguely understood and largely undocumented among child care
providers. Despite this inclination, evidence about the connection
between space and effectiveness has been found even when physical space
is not the focal point of the research undertaken. A study conducted at
the School for Young Children (SYC), a distinguished preschool program
housed at St. Joseph College in West Hartford, Connecticut, provides a
compelling example.\4\
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\4\ Tony Proscio, Carl Sussman & Amy Gillman, Authors, Child Care
Facilities: Quality by Design, (2004). http://www.lisc.org/content/
publications/detail/815 .
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Every State has a minimum adult-child ratio for licensed centers,
in large part because attention from nurturing adults is a prime
indicator of quality in child care programs. SYC is a highly regarded
preschool program with a more than ample staffing ratio; the program is
largely viewed as meeting if not exceeding minimum quality standards.
Yet, when a research team set out to monitor enrolled children's
contact with adults during free play time they found shocking results:
Only 3 percent of the children's time was spent engaged in meaningful
interactions with a teacher.
While the SYC executive director was digesting the researchers'
negative findings in order to develop a workable solution, her
organization moved to new accommodations. A routine follow-up test in
the new space immediately showed a strikingly higher result. Teacher-
child interactions increased to 22 percent. There had been no change in
the management, staff, or program, only the physical space. The new
space, which Bye had taken pains to design, was considerably roomier
and there were bathrooms, telephones, storage space, and other
logistical necessities in each classroom. Adults no longer had to leave
the room to escort children to the bathroom, retrieve or store
supplies, or take a phone call. Fewer distractions and interruptions
for adults naturally meant more time for children.
Both children and staff benefited from the new space configuration.
The more generous square footage allowed staff to configure each
classroom into well-defined areas for different activities. Children
were no longer crowded together into inadequate space and distracted by
one another, so they ran into conflicts less often, and had better play
experiences--making their interactions with adults and other children
more constructive. Teachers were able to use their time in a more
effective and rewarding way, resulting in higher morale and lower staff
turnover for. Overall, the effect of the new space on the content of
the program was considerable and measurable--even when not a single
change had been made in the program itself.
Space matters: a facility's layout, size, materials and design
features can improve program quality and contribute positively to child
development while a poorly adapted and overcrowded environment
undermines it.\5\ Bathrooms adjacent to classrooms, accessible cubbies,
and child-sized sinks, counters, furnishings and fixtures increase
children's autonomy and competence while decreasing the demands on
teachers. Early learning centers with ample classrooms divided into
well-configured activity areas support uninterrupted self-directed pay
and exploration. The physical configuration of early care and education
spaces directly affect adult/child interaction and influence how
children grow and learn.
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\5\ http://www.lisc.org/docs/publications/2007
_nieer_cick_facilities_brief.pdf
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The National Association for the Education of Young Children
(NAEYC) acknowledges the importance of a quality environment in the
following statement: ``The physical environment sets the stage and
creates the context for everything that happens in any setting--a
classroom, a play yard, a multipurpose room. A high-quality environment
welcomes children; engages children in a variety of activities;
provides space for individual, small-group, and large-group activities;
and generally supports the program's philosophy and goals. Ultimately,
the physical environment must convey values and messages about who is
welcomed, what is important, and what the beliefs are about how
children learn.'' \6\
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\6\ http://www.naeyc.org/store/node/402
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What Facilities Experts Know
Although physical spaces play an important role in promoting
program quality and healthy development, it is rare to find high
quality facilities designed to meet the unique needs of very young
children, especially in low-income communities. Early childhood
specialists have long maintained that the physical environments where
learning takes place--and where young children spend the majority of
their waking hours--significantly influence the quality of early care
and education programs.
Facilities experts and those proficient in financing the design,
acquisition, construction, and improvement of early care and education
spaces concur and largely agree that:
--Well-designed facilities enhance child development and program
quality;
--An adequate supply of facilities is needed to support rapidly
increasing preschool education programs;
--The quality and location of the facilities can encourage enrollment
and parent involvement;
--Facilities can help promote a positive workplace in an industry
challenged to retain experienced teachers;
--Child care program income, especially in low-income communities, is
typically not sufficient to cover the full cost of delivering
quality early education services and doesn't allow for the
added cost of constructing or improving appropriate facilities;
and
--Few centers have the experience or personnel to handle the
complexities of real estate development tasks and require
specialized technical assistance to address their facilities
needs.
Early Childhood Facilities Financing Challenges
Despite what is known about the importance of the spaces where
learning takes place, there is no dedicated source of capital to help
early care and education programs develop well-designed facilities
suitable for our youngest learners. Programs serving low-income
communities are highly dependent on public operating revenues that
don't cover the cost of purchasing or renovating an appropriate
facility. Without a consistent and effective financing system or
capital subsidies, providers are left to pursue piecemeal approaches,
cobbling together small donations and grants from a variety of sources.
This prevents the early childhood field from addressing its physical
facility needs and creating the kind of environments that support high
quality programs.
Historically, private financial institutions have not made
significant infrastructure investments in early care and education--
particularly in economically distressed areas. Few mainstream banks,
credit unions, and lending institutions are willing to finance early
childhood facility projects, which tend to require relatively small,
complex loans often characterized by uncertain future funding for
repayment through government operating subsidies. The projects
generally have little to no equity, and limited collateral value. In
addition, private banks typically don't employ staff with specialized
knowledge of the child care sector, consequently they are unable to
understand the needs of child care or preschool centers and assist
program directors lacking experience with real estate development and
financing.
Certified Community Development Financial Institutions (CDFI)
working in market niches that are underserved by traditional financial
entities are among the small number of organizations who have made
investments in early childhood physical spaces. They have a proven
track record in economically challenged regions and are experienced
with providing a unique range of financial products and services that
spur private investment in their target markets. Unfortunately, given
the limited funding available to CDFIs to carry out their comprehensive
mission, demand for early childhood facilities capital far outstrips
supply.
recommendations
As Congress considers ways to help children get an early start on
the pathway to success, we urge you to:
1. Recognize the critical role that early childhood facilities
play in preparing young children for achievement in school and
in life.
Congress has the power to influence and support State and local
early childhood priorities. We believe that conversations about
early care and education should always acknowledge the
significant impact of early childhood physical settings on
early learning.
2. Ensure that Federal policies adequately finance the
acquisition, construction, and improvement of early care and
education spaces.
Currently, there is no dedicated source of funding for the
acquisition, construction, and improvement of early care and
education spaces. Additionally, the economic instability of the
past 5 years has resulted in very little investment in early
childhood physical infrastructure. Capital must be available in
order for early care and education providers to create high
quality physical spaces that promote early learning. We are
encouraged by the national dialogue on the importance of
investments in early childhood development, and request that
you create the supportive policy, regulatory, and funding
environment that is needed to enable the early care and
education field to meet its physical capital needs.
conclusion
As investments are made to increase access to preschool and child
care, attention must be paid to the physical environment where many
young children spend the majority of their waking hours. Without
support for facilities, programs will locate in the least expensive and
most readily available spaces--makeshift, donated, or surplus space
such as basements and storefronts or outdated classrooms for older
students that have not been adapted for our youngest children and fall
far short of standards to support high quality programs.
We look forward to continuing conversations with you and your
staff. Our organization serves on the Executive Committee of the
National Children's Facilities Network (NCFN), a coalition of like-
minded nonprofit financial and technical assistance intermediaries
involved in planning, developing, and financing facilities for low-
income child care and early education programs. Both LISC and NCFN
would welcome an opportunity to serve as a resource.
Thank you again for your leadership.
[This statement was submitted by Matthew Josephs, Senior Vice
President, Policy, and Amy Gillman, Senior Program Director, Community
Investment Collaborative For Kids.]
______
Prepared Statement of the March of Dimes Foundation
MARCH OF DIMES: FISCAL YEAR 2015 FEDERAL FUNDING PRIORITIES
[Dollars in thousands]
------------------------------------------------------------------------
Fiscal year 2015
Program request
------------------------------------------------------------------------
National Institutes of Health (Total)................ 32,000,000
National Institute of Child Health and Development... 1,370,000
National Human Genome Research Institute............. 536,967
National Institute on Minority Health and Disparities 289,426
Centers for Disease Control and Prevention (Total)... 7,800,000
National Center for Birth Defects and Developmental 139,000
Disabilities........................................
Birth Defects Research and Surveillance............. 22,300
Folic Acid Campaign................................. 2,800
Immunizations........................................ 720,000
Polio Eradication.................................... 146,000
Safe Motherhood Initiative........................... 46,000
Preterm Birth....................................... 2,000
National Center for Health Statistics................ 182,000
Health Resources and Services Administration (Total). 7,480,000
Title V, Maternal and Child Health Block Grant....... 639,000
SPRANS- Infant Mortality and Preterm Birth.......... 3,000
Heritable Disorders.................................. 18,000
Universal Newborn Hearing............................ 18,660
Healthy Start........................................ 103,532
Children's Hospitals Graduate Medical Education...... 300,000
Agency for Healthcare Research and Quality (Total)... 375,000
------------------------------------------------------------------------
The three million volunteers and 1,200 staff members of the March
of Dimes Foundation appreciate the opportunity to submit Federal
funding recommendations for fiscal year 2015. The March of Dimes is a
unique partnership of scientists, clinicians, parents, members of the
business community and other volunteers affiliated with chapters in
every State, the District of Columbia and Puerto Rico. The March of
Dimes recommends the following funding levels for programs and
initiatives that are essential investments in maternal and child
health.
preterm birth
Preterm birth is a serious health problem that costs the United
States more than $26 billion annually. Employers, private insurers and
individuals bear approximately half of the cost of healthcare for these
infants, and another 40 percent is paid by Medicaid. One in nine
infants in the U.S. is born preterm. Prematurity is the leading cause
of newborn mortality and the second leading cause of infant mortality.
Among those who survive, one in five faces health problems that persist
for life such as cerebral palsy, intellectual disabilities, chronic
lung disease, and deafness. For the past 6 years preterm birth rates
have declined, resulting in 176,000 fewer babies being born preterm and
saving more than $9 billion. The March of Dimes believes a key factor
behind this continued decline was Congress' passage of the 2006 PREEMIE
Act (Public Law 109-450), which brought the first-ever national focus
to prematurity prevention and generated a public-private agenda to spur
innovative research at the National Institutes of Health (NIH) and
Centers for Disease Control and Prevention (CDC) and advanced evidence-
based interventions to prevent preterm birth. In 2013 Congress passed
the PREEMIE Reauthorization Act (Public Law 113-55), which renews our
Nation's commitment to giving every baby a healthy start. The March of
Dimes' fiscal year 2015 funding requests regarding preterm birth are
based on continuing to enhance public and private investment into
understanding the causes of preterm birth and promoting known
interventions.
Eunice Kennedy Shriver National Institute of Child Health and Human
Development (NICHD)
The March of Dimes recommends at least $32 billion for the National
Institutes of Health and $1,370 billion for the NICHD in fiscal year
2015. This funding will allow NICHD to sustain its preterm birth-
related research through extramural grants, Maternal-Fetal Medicine
Units, the Neonatal Research Network and the intramural research
program. This funding would also allow for NICHD to continue
investments in transdisciplinary research to identify the causes of
preterm birth, as recommended in the Director's 2012 Scientific Vision
for the next decade, the Institute of Medicine 2006 report on preterm
birth, and the 2008 Surgeon General's Conference on the Prevention of
Preterm Birth. The March of Dimes fully supports NICHD's pursuit of
transdisiplinary science, which facilitates the exchange of scientific
ideas and leads to novel approaches to understanding complex health
issues and their prevention.
Centers for Disease Control and Prevention--Preterm Birth
The mission of the CDC's National Center for Chronic Disease
Prevention and Health Promotion's Safe Motherhood Initiative is to
promote optimal reproductive and infant health. The March of Dimes
recommends funding of $46 million for the Safe Motherhood program and
re-instatement of the preterm birth sub-line at $2 million, as
reauthorized in the PREEMIE Reauthorization Act, to reflect current
preterm birth research within the CDC.
The CDC funds state-based Perinatal Quality Collaboratives,
networks of hospitals, healthcare providers, State health departments,
consumer groups, and others that advance evidence-based clinical
practices and processes. These networks collect data in real time on
healthcare practices and outcomes and provide immediate feedback for
quality improvement. For example, the New York State Obstetrical and
Neonatal Quality Collaborative reduced deliveries without indication
from 25 percent in 2010 to 7-8 percent in 2012. Reducing elective
deliveries before 39 weeks gestation is a proven way to lower preterm
birth and improve infant outcomes.
Health Resources and Services Administration (HRSA)--Preterm Birth
The March of Dimes recommends the Subcommittee specify $3 million
within the Title V Special Projects of Regional and National
Significance account be used to support current preterm birth and
infant mortality initiatives, as authorized in the PREEMIE Act, and to
support the expansion of its initiatives nationwide. The PREEMIE
Reauthorization Act renewed preterm birth-related demonstration
projects, which are aimed at improving education, treatment and
outcomes for babies born preterm. This funding will support HRSA's
Collaborative Improvement & Innovation Network (COIIN) to Reduce Infant
Mortality, which assists State agencies focusing on a range of
interventions proven to reduce preterm birth and improve maternal and
child health.
birth defects
According to the CDC, an estimated 120,000 infants in the U.S. are
born with major structural birth defects each year. Birth defects are
the leading cause of infant mortality and the causes of more than 70
percent are unknown. Federal investments are sorely needed to support
research to discover the causes of all birth defects and for the
development of effective interventions to prevent them or reduce their
prevalence.
CDC--National Center on Birth Defects and Developmental Disabilities
(NCBDDD)
For fiscal year 2015, the March of Dimes recommends funding of $139
million for NCBDDD. We also request the Subcommittee provide at least
$22.3 million to support birth defects research and surveillance and
$2.8 million to support folic acid education. Birth defects research
and surveillance activities have been severely curtailed due to funding
reductions which means a slowed pace to research identifying causes of
birth defects and decreased ability to track birth defects and connect
families to services. Specifically, two Centers for Birth Defects
Research and Prevention have been eliminated. Specific expertise from
the previously funded Centers in Texas and Utah (medications used
during pregnancy, environmental exposures of concern, maternal
infections, and birth defects risk among Hispanics) is no longer
contributing to the study and 25 percent fewer families are
participating in CDC birth defects research. Birth defects surveillance
programs funded by NCBDDD have gone from 28 in 2004 to 14 in 2013, with
a 40 percent (800,000) reduction in the number of live births monitored
by States.
newborn screening
Newborn screening is a vital public health activity designed to
identify genetic, metabolic, hormonal and functional disorders in
newborns. Screening detects conditions in newborns that, if left
untreated, can cause disability, developmental delays, intellectual
disabilities, serious illnesses or even death. If diagnosed early, many
of these disorders can be managed successfully. The March of Dimes
urges the Subcommittee to provide $18 million for HRSA's heritable
disorders program, which plays a critical role in assisting States in
the adoption of additional screenings, enhancing provider and consumer
education, and ensuring coordinated follow-up care. Also funded by this
program is the work of the Advisory Committee on Heritable Disorders in
Newborns and Children, which provides States with a Recommended Uniform
Screening Panel (RUSP) to ensure that every infant is screened for
conditions having a known treatment. The RUSP has helped bring about
comprehensive newborn screening in every State. In 2007, only 10 States
and DC required infants to be screened for the recommended disorders;
today, 42 States and DC require screening of at least 29 of the 31
treatable conditions.
closing
The Foundation's volunteers and staff in every State, the District
of Columbia and Puerto Rico look forward to working with Members of
this Subcommittee to secure the resources needed to improve the health
of the Nation's mothers, infants and children.
______
Prepared Statement of The Marfan Foundation
Chairman Harkin and distinguished members of the Subcommittee,
thank you for your time and your consideration of the priorities of the
heritable connective tissue disorders community as you work to craft
the fiscal year 2015 Labor, Health and Human Services Appropriations
Bill.
about marfan syndrome and heritable connective tissue disorders
Marfan Syndrome
Marfan syndrome is a genetic disorder that affects the body's
connective tissue. Connective tissue holds all the body's cells, organs
and tissue together. It also plays an important role in helping the
body grow and develop properly.
Connective tissue is made up of proteins. The protein that plays a
role in Marfan syndrome is called fibrillin-1. Marfan syndrome is
caused by a defect (or mutation) in the gene that tells the body how to
make fibrillin-1. This mutation results in an increase in a protein
called transforming growth factor beta, or TGF-b. The increase in TGF-b
causes problems in connective tissues throughout the body, which in
turn creates the features and medical problems associated with Marfan
syndrome and some related disorders.
Because connective tissue is found throughout the body, Marfan
syndrome can affect many different parts of the body, as well. Features
of the disorder are most often found in the heart, blood vessels,
bones, joints, and eyes. Some Marfan features--for example, aortic
enlargement (expansion of the main blood vessel that carries blood away
from the heart to the rest of the body)--can be life-threatening. The
lungs, skin and nervous system may also be affected. Marfan syndrome
does not affect intelligence.
Related Conditions
There are disorders related to Marfan syndrome that can cause
people to struggle with some of the same or similar physical problems.
Some examples are Loeys-Dietz syndrome, Ehlers-Danlos syndrome, and
Familial Thoracic Aortic Aneurysm and Dissection.
Disorders related to Marfan syndrome can also cut lives short,
particularly when they go unchecked, and they can deeply affect the
quality of life of the individuals and families who must cope with
them. Just like people with Marfan syndrome, those affected by related
disorders need early and accurate diagnosis to ensure they receive
proper care and treatment.
Many of these disorders are genetic conditions that, like Marfan
syndrome, cause the aorta (the main blood vessel that carries blood
from the heart to the rest of the body) to enlarge, a problem that
requires medicine and regular monitoring to determine appropriate
treatment. Other features that may overlap with Marfan syndrome include
those involving the heart, bones, joints and eyes. Related connective
tissue disorders include:
--Loeys-Dietz Syndrome
--Ehlers-Danlos Syndrome
--Familial Thoracic Aortic Aneurysm and Dissection
--Mass Phenotype
--Ectopia Lentis Syndrome
--Beals Syndrome
--Bicuspid Aortic Valve
--Stickler Syndrome
--Shprintzen-Goldberg Syndrome
about the foundation
The Marfan Foundation creates a brighter future for everyone
affected by Marfan syndrome and related disorders.
--We pursue the most innovative research and make sure that it
receives proper funding.
--We create an informed public and educated patient community to
increase early diagnosis and ensure life-saving treatment.
--We provide relentless support to families, caregivers, and
healthcare providers.
We will not rest until we've achieved victory--a world in which
everyone with Marfan syndrome or a related disorder receives a proper
diagnosis, gets the necessary treatment, and lives a long and full
life.
one family's story
Hector Roman was 36 years old when he died on June 25, 2012, of an
aortic dissection caused by Marfan syndrome. He was never diagnosed
with Marfan syndrome--despite being treated by several medical
specialists for myriad health issues--and he did not know he was a risk
of a sudden early death. He was in pain for days and didn't rush to the
hospital because he was frustrated with the lack of help he was getting
with his health concerns. He had no idea this delay would be deadly.
After a few days in pain, he went into shock and a friend call 911. He
died 3 days later during his third surgery.
Now, his partner, Teresita Mompeller, of Phoenix, AZ, is raising
their three boys--Jovan,5, Joel, 3, and Justus, 2--alone. After Hector
died, Teresita learned about Marfan syndrome. Most alarming to her was
that affected people have a 50 percent chance of passing it to their
offspring. She had her sons checked immediately. Joel and Justus have
been diagnosed with Marfan syndrome and already have aortic
enlargement. While their condition is the same as their dad; their
prognosis is better. The boys can live a normal life span because they
have the diagnosis and are being monitored. They can avoid a fatal
situation because they know.
Teresita, who has a Facebook page called ``Do You Know Marfan?''
(and a parallel page in Spanish) recently wrote: ``Thanks to the work
of The Marfan Foundation, I know that my boys have a greater chance of
living a long life. I know first-hand what it is to be a mother with
many questions and concerns about a rare disorder that nobody seemed to
know anything about. The Marfan Foundation has guided me through all of
my concerns. They have given me all the support and information needed
to advocate for my children [so they receive] proper treatment. The
Foundation has given me and thousands of other people, the peace of
mind that they are working hard to better the lives of those
affected.''
sequestration
We have heard from the medical research community that
sequestration and deficit reduction activities have created serious
issues for Federal funding opportunities and the career development
pipeline. In order to ensure that research into heritable connective
tissue disorders can continue to move forward, and, more importantly,
to ensure that our country is adequately preparing the next generation
of young investigators, we urge you to avert, mitigate, or otherwise
eliminate the specter of sequestration. While the Foundation has
anecdotal accounts of the harms of sequestration, the Federated
American Societies for Experimental Biology has reported:
--In constant dollars (adjusted for inflation), the NIH budget in
fiscal year 2013 was $6 billion (22.4 percent) less than it was
in fiscal year 2003.
--The number of competing research project grants (RPGs) awarded by
NIH has also fallen sharply since fiscal year 2003. In fiscal
year 2013, NIH made 8,283 RPG awards, which is 2,110 (20.3
percent) fewer than in fiscal year 2003.
--Awards for R01-equivalent grants, the primary mechanism for
supporting investigator-initiated research, suffered even
greater losses. The number awarded fell by 2,528 (34 percent)
between fiscal year 2003 and fiscal year 2013.
The pay line for some NIH funding mechanisms has fallen from 18
percent to 10 percent while the average age for a researcher to receive
their first NIH-funded grant has climbed to 42. These are strong
disincentives to choosing a career as a medical researcher. Our
scaling-back is occurring at a time when many foreign countries are
investing heavily in their biotechnology sectors. China alone plans to
dedicate $300 million to medical research over the next 5 years; this
amount is double the current NIH budget over the same period of time.
Scientific breakthroughs will continue, but America may not benefit
from the return-on-investment of a robust biotechnology sector. For the
purposes of economic and national security, as well as public health,
the Foundation asks that you work with your colleagues to eliminate
sequestration and recommit to supporting this Nation's biomedical
research enterprise.
centers for disease control and prevention
People with Marfan syndrome are born with it, but features of the
disorder are not always present right away. Some people have a lot of
Marfan features at birth or as young children--including serious
conditions like aortic enlargement. Others have fewer features when
they are young and don't develop aortic enlargement or other signs of
Marfan syndrome until they are adults. Some features of Marfan
syndrome, like those affecting the heart and blood vessels, bones or
joints, can get worse over time.
This makes it very important for people with Marfan syndrome and
related disorders to receive accurate, early diagnosis and treatment.
Without it, they can be at risk for potentially life-threatening
complications. The earlier some treatments are started, the better the
outcomes are likely to be.
Knowing the signs of Marfan syndrome can save lives. Our community
of experts estimates that nearly half the people who have Marfan
syndrome don't know it. CDC and NCBDDD have critical programs that can
help improve awareness and recognition of warning signs, which can save
lives. Some of these programs including CDC's Million Hearts Campaign
and NCBDDD's newborn screening activities. Meaningful funding increases
will allow CDC and NCBDDD to expand their successful awareness efforts
to include additional conditions.
national institutes of health
NIH has worked closely with the Foundation to investigate the
mechanisms of these conditions. In recent decades, this research has
yielded significant scientific breakthroughs that have the potential to
improve the lives of affected individuals. In order to ensure that the
heritable connective tissue disorders research portfolios can continue
to expand and advance, NIH requires meaningful funding increases to
invest in emerging and promising activities.
NHLBI
The Marfan Foundation anxiously await the results of this first-
ever multicenter clinical trial for our patient population conducted by
the National Heart, Lung and Blood Institute's Pediatric Heart Network
(PHN). After 4 years of recruitment and 3 years of follow-up
evaluations, the results are expected to be released in November 2014
at the American Heart Association Meeting. 604 Marfan syndrome patients
(age 6 months to 25 years) are enrolled in the study. Patients are
randomized onto either losartan or atenolol (a beta blocker that is the
current standard of care for Marfan patients with an enlarged aortic
root). The Marfan Foundation thanks both NHLBI and NIAMS for their
dedicated support and careful execution of this trial.
NEI
Ectopia lentis, dislocation of the lens, occurs in up to 60 percent
of patients with Marfan syndrome. The central positioning of the lens
depends on the zonule of Zinn, a fibrous structure which has fibrillin-
1 as a major component. NEI-supported investigators are studying the
protein interactions of fibrillin-1 in health and disease in the zonule
of Zinn to understand the disease mechanisms that cause ectopia lentis.
It is hoped that this research will provide therapeutic insights to
better treat this complication of Marfan syndrome.
NIAMS
NIAMS continues to support the Consortium for Translational
Research in Marfan Syndrome, which is investigating the disease process
in MFS. These studies, building on previous advances, are aimed at
identifying new biological targets for therapy, as well as predictive
biomarkers of vascular and skeletal manifestations, which are the major
causes of mortality and morbidity in MFS.
ORDR
The National Center for Advancing Translational Sciences houses
ORDR and leads other important activities. In addition to the Rare
Disease Clinical Research Consortia, translational treatment
development programs hold promise for the heritable connective tissue
disorders community.
______
Prepared Statement of Mary A. Vitale, Guardian/Sibling/Advocate
Dear Committee Members: The opportunity to submit personal
testimony to this committee is much appreciated. As 2015 appropriation
requests are being considered, this submission of testimony is a
request for a review of the misuse of Federal funds by the Health and
Human Services (HHS) agencies that promote forced
deinstitutionalization of persons with severe and profound intellectual
disabilities.
I have been an active guardian for 35 years for my 61 year old
brother who has severe intellectual disabilities, behavior challenges,
and ongoing medical concerns. He has never been able to walk or talk.
He has only partial use of one of his arms. He needs maximum assistance
for all his needs. Despite his many disabilities, he is a happy man.
His care at his intermediate care facility for individuals with
intellectual disabilities (ICF/IID) home is successful, stable,
sustainable, consistent, comprehensive, and cost-effective.
HHS agencies, such as State Planning Councils and State Protection
and Advocacy Services, are misusing Federal funds to promote the
closing of ICF/IID homes like where my brother lives, despite the
objections of legal guardians.
The Supreme Court 1999 Olmstead ruling states: ``It would be
unreasonable, it would be a tragic event, then, were the Americans with
Disabilities Act of 1990 (ADA) to be interpreted so that States had
some incentive, for fear of litigation to drive those in need of
medical care and treatment out of appropriate care and into settings
with too little assistance and supervision.''
To the great dismay of families, this ``tragic event'' is exactly
what is happening across the United States by the misuse of HHS
funding.
Appropriate, cost-effective care for those with the severest
disabilities is available in ICF/IID homes, and yet they are
aggressively targeted for closure, flagrantly ignoring the educated
choice of guardians.
Many community settings have too little assistance and too little
supervision to be appropriate for those with severe multiple
intellectual and physical impairments. Tragically, the result is an
increase in neglect and abuse.
I ask each member of this committee to seriously question HHS about
misusing Federal funds to promote forced total deinstitutionalization
for persons with intellectual disabilities. Help us keep our beloved
family members safe and healthy.
______
Prepared Statement of the Meals On Wheels Association of America
Chairman Harkin and Ranking Member Moran: Thank you for the
opportunity to present testimony to your Subcommittee concerning fiscal
year 2015 funding for Older Americans Act (OAA) Nutrition Programs
administered by the Administration for Community Living/Administration
on Aging within the U.S. Department of Health and Human Services. We
are sincerely grateful for your longstanding support, as well as your
leadership in ensuring that these programs received a restoration of
funding in fiscal year 2014 over the devastating fiscal year 2013
sequestration cuts.
Last month, we sent a joint letter with the National Association of
Nutrition and Aging Services Program (NANASP) to you, Chairman Mikulski
and Ranking Member Shelby urging increased investments in OAA Nutrition
Programs, including the Congregate Nutrition Program, Home-Delivered
Nutrition Program (commonly referred to as Meals on Wheels), and the
Nutrition Services Incentive Program. Specifically, we requested
funding these programs at their fiscal year 2010 levels--totaling $819
million. During the fiscal year 2015 appropriations process, we implore
you to give this modest request your utmost consideration due to the
significant moral and economic benefits these programs offer.
This week, a new report released by the National Foundation to End
Senior Hunger shows that nearly 9.3 million Americans over the age of
60 struggled with hunger in 2012, up from 8.8 million in 2011--and a
28% increase since the start of the recession in 2007. Because OAA
funding has not kept pace with needs, the chasm continues to widen.
Through OAA Nutrition Programs, we are only able to provide nutritious
meals to 2.5 million of them,\1\ leaving a staggering gap of nearly 7
million seniors still in need. The infrastructure and network exists to
serve more of our seniors in need, but the financial resources fall
substantially short. That is why we are asking for a critical boost in
funding levels.
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\1\ 2011 Older Americans Act State Program Reports. U.S. Department
of Health and Human Services, Administration on Aging. March 2013.
http://www.agid.acl.gov/.
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Senior hunger is a growing epidemic that has serious implications
for our current and future Mandatory spending. Without proper nutrition
and the critical social connection that comes along with it, one's
health deteriorates and inevitably fails. It is extremely costly not
only in personal terms for the individuals who struggle with hunger,
but also for our Nation in terms of increased healthcare costs. As
such, we hope that you recognize the need to invest in Discretionary
programs, like OAA Nutrition Programs, that help prevent and mitigate
the effects of chronic diseases, improve quality of life, expedite
recovery after an illness or injury, and reduce unnecessary Medicare
and Medicaid expenses both today and in the future. These programs are
part of the solution to our Nation's fiscal challenges.
For over 40 years, OAA Nutrition Programs in communities large and
small, urban and rural have been effectively serving our country's most
vulnerable, frail and isolated seniors. What started as a demonstration
project has grown into a highly effective community-based, nationwide
network of more than 5,000 local programs. While not all programs
receive OAA funds, the majority rely, in part, on the Federal dollars
authorized under Title III of the Act as a foundation on which to
leverage other funding. This enables a very successful public-private
partnership to help raise the remaining resources needed to provide
daily nutritious meals and social contact to seniors 60 years of age
and older who are at significant risk of hunger and losing their
ability to remain independent and able to live in their homes.
The evidence demonstrates that these programs are not only saving
lives and taxpayer dollars every day, but they are doing precisely what
they were designed to do by effectively reaching our Nation's most at-
risk seniors.
Data from the 2012 National Survey of OAA Participants shows that
the seniors receiving Meals on Wheels and congregate meals are
primarily over age 75, impoverished, live alone, are in poor health and
functionally impaired. For the majority of the individuals served, the
meal that they receive provides one half or more of their total food
for the day.
Of the seniors receiving Meals on Wheels:
--60 percent have six to 14 chronic health conditions
--51 percent take from six to at least 23 medications daily
--29 percent have three or more limitations in everyday activities,
such as bathing, getting dressed and toileting
Of the seniors receiving congregate meals:
--40 percent have six to 14 chronic health conditions
--29 percent take from six to at least 23 medications daily
--50 percent have at least one limitation in everyday activities,
such as preparing meals or grocery shopping
Each day, Meals on Wheels programs in Iowa, Kansas and in every
State across the Nation are serving far more than just meals to seniors
in need. They are delivering a caring and efficient service--nutritious
meals, friendly visits, and safety checks--enabling more than 2.5
million seniors to continue to live independently in their own homes
and without the worry of hunger and isolation. In short, these programs
are a lifeline.
The following comments from individuals served illustrate the
degree to which these OAA Nutrition Programs are delivering far more
than just a meal.
--``The companionship and fellowship as well as the nutritious meals
keep me getting up in the morning, getting dressed and to the
site to eat.''
--``My husband needs lots and lots of help . . . If it wasn't for
meals, I wouldn't be able to continue taking care of him in our
home.''
--``If it wasn't for Meals on Wheels, I would starve.''
--``Once a day a knock at my door means I eat for that day.''
--``I am so grateful for the volunteer drivers . . . sometimes it is
the only human contact I have for days.''
--``I had major surgery. I feel these meals are big step toward
keeping me from going to a nursing home.''
--``I do not get much social security so at least I have food to eat;
this is my only meal; I am 89 and need Meals on Wheels or I
can't stay in my home; the friendly volunteers are the only
people I see most days.'' \2,3\
---------------------------------------------------------------------------
\2\ Lloyd, Jean & Greuling, Holly. The Older Americans Act
Nutrition Program Sets a New Table. Aging Today Online. American
Society on Aging. March 2014. http://bit.ly/ONK7eK.
\3\ Don't Empty My Plate Campaign: http://bit.ly/1oUgRQ9 and http:/
/bit.ly/1jvLSGO.
---------------------------------------------------------------------------
Beyond the real people and lives these programs impact on a daily
basis, there is increasing and irrefutable evidence that improving and
bolstering funding for OAA Nutrition Programs will substantially reduce
healthcare costs--both in the short- and long-term. A recent report
from the Center for Effective Government found that for every $1
invested in Meals on Wheels, up to $50 could be saved in Medicaid
alone.\4\ Brown University conducted a recent study which found that by
investing more in Meals on Wheels, more seniors can be kept out of
nursing homes. Specifically, the research found that for every
additional $25 a State spends on home-delivered meals each year, per
person over 65, the low-care nursing home population--seniors who are
nursing home eligible but could remain in their homes with only a
little outside support--decreases by a percentage point.\5\ One
percentage point can translate to billions of dollars in savings
annually.
---------------------------------------------------------------------------
\4\ Schieder, Jessica & Lester, Patrick. Sequestering Meals on
Wheels Could Cost the Nation $489 Million per year. The Center for
Effective Government. April 2013. http://bit.ly/16jmmRU.
\5\ Thomas, Kali & Mor, Vincent. The Relationship between Older
Americans Act Title III State Expenditures and Prevalence of Low-Care
Nursing Home Residents. Brown University. December 2012. http://bit.ly/
16wl0B2.
---------------------------------------------------------------------------
On top of the social and economic cases for investing in OAA
Nutrition Programs, the public overwhelmingly supports them. In fact,
an October 2013 survey found that 7 in 10 Americans agree that the
government should pay for Meals on Wheels.\6\ The growing problem of
senior hunger in America requires the continued public-private
partnerships that have been a pivotal foundation; however, the Federal
Government must serve as the strongest and most reliable fiscal partner
by elevating its support to higher levels that keep pace with a rapidly
aging population, increased need and ever-rising costs.
---------------------------------------------------------------------------
\6\ SSRS, independent research company. Survey among a nationally
representative sample of respondents age 18+. October 2013.
---------------------------------------------------------------------------
We understand the difficult decisions you and your colleagues are
tasked with in fiscal year 2015 and beyond. However, the evidence
demonstrates that these programs are not only saving lives and taxpayer
dollars every day, but they are effectively reaching our Nation's most
vulnerable seniors and have the capacity to serve more if properly
resourced. In short, these proven and effective programs are a part of
the solution to our Nation's fiscal challenges and should be looked to
as such.
As your Subcommittee crafts and considers the fiscal year 2015
Labor-HHS-Education appropriations bill, we ask that you provide fiscal
year 2010 appropriations levels for all three nutrition programs
authorized under the OAA--Congregate Nutrition Program, Home-Delivered
Nutrition Program, and the Nutrition Services Incentive Program. You
have the ability to shorten waiting lists and increase the number of
nutritious meals we can serve to seniors today. At the same time you
will be investing in a stronger fiscal path for our country by reducing
future healthcare costs.
Again, we thank you for the opportunity to present this testimony
to you, and for your continued support.
______
Prepared Statement of the Medical Library Association and Association
of Academic Health Sciences Libraries
summary of fiscal year 2015 recommendations
--Continue the commitment to the National Library of Medicine (NLM)
by supporting the President's budget proposal which requests
$372.85 million, and an additional $8.2 million from amounts
under Section 241 of the Public Health Service Act, for the
National Information Center on Health Services Research and
Health Care Technology.
--Continue to support the medical library community's role in NLM's
outreach, telemedicine, disaster preparedness, health
information technology initiatives, and healthcare reform
implementation.
introduction
The Medical Library Association (MLA) and Association of Academic
Health Sciences Libraries (AAHSL) thank the Subcommittee for the
opportunity to submit testimony regarding fiscal year 2015
appropriations for the National Library of Medicine (NLM), an agency of
the National Institutes of Health (NIH). Working in partnership with
the NIH and other Federal agencies, NLM is the key link in the chain
that translates biomedical research into practice, making the results
of research readily available to all who need it.
NLM Leverages NIH Investments in Biomedical Research
In today's challenging budget environment, we recognize the
difficult decisions Congress faces as it seeks to improve our Nation's
fiscal stability. We thank the Subcommittee for its long-standing
commitment to strengthening NLM's budget. While extramural funding
comprises the largest portion of funding for institutes within the NIH,
some eighty percent of NLM's budget supports intramural services and
programs that sustain the Nation's biomedical research enterprise and
more--it builds, sustains, and augments NLM's suite of more than 200
databases which provide information access to health professionals,
researchers, educators, and the public. Intramural funding also
supports all aspects of library operations and programs, including the
acquisition, organization, preservation, and dissemination of the
world's biomedical literature, no matter the medium.
In fiscal year 2015 and beyond, it is critical to continue
augmenting NLM's baseline budget to support expansion of its
information resources, services, and programs which collect, organize,
and make readily accessible rapidly expanding biomedical knowledge
resources and data. NLM maximizes the return on the investment in
research conducted by the NIH and other organizations. The Library
makes the results of biomedical information more accessible to
researchers, clinicians, business innovators, and the public, enabling
such data and information to be used more efficiently and effectively
to drive innovation and improve health. NLM is a leader in Big Data and
plays a critical role in accelerating nationwide deployment of health
information technology, including electronic health records (EHRs), by
leading the development, maintenance and dissemination of key standards
for health data interchange that are now required of certified EHRs.
NLM also contributes to Congressional priorities related to drug safety
through its efforts to expand its clinical trial registry and results
database (ClinicalTrials.gov) in response to legislative requirements,
and to the Nation's ability to prepare for and respond to disasters.
Growing Demand for NLM's Basic Services
NLM delivers more than a trillion bytes of data to millions of
users daily that helps researchers advance scientific discovery and
accelerate its translation into new therapies; provides health
practitioners with information that improves medical care and lowers
its costs; and gives the public access to resources and tools that
promote wellness and disease prevention. Every day, medical librarians
across the Nation use NLM services to assist clinicians, students,
researchers, and the public in accessing information they need to save
lives and improve health. Without NLM, our Nation's medical libraries
would be unable to provide the quality information services that our
Nation's health professionals, educators, researchers and patients
increasingly need.
NLM's data repositories and online integrated services such as
GenBank, PubMed, and PubMed Central are revolutionizing medicine and
ushering in an era of personalized medicine in which care is based on
an individual's unique genetic profile. GenBank is the definitive
source of gene sequence information. PubMed, with more than 23 million
citations to the biomedical literature, is the world's most heavily
used source of bibliographic information. Approximately 760,000 new
citations were added in fiscal year 2013, and the database provided
high quality medical information to about 2.3 million users each day.
PubMed Central is NLM's digital archive which provides public access to
the full-text versions of more than 3 million biomedical journal
articles, including those produced by NIH-funded researchers. On a
typical weekday more than one million users download 1.65 million full-
text articles, including those submitted in compliance with the NIH
Public Access Policy.
As the world's largest and most comprehensive medical library,
NLM's traditional print and electronic collections continue to steadily
increase each year, standing at more than 21 million items--books,
journals, technical reports, manuscripts, microfilms, photographs and
images. By selecting, organizing and ensuring permanent access to
health sciences information in all formats, NLM ensures the
availability of this information for future generations, making it
accessible to all Americans, irrespective of geography or ability to
pay, and guaranteeing that citizens can make the best, most informed
decisions about their healthcare.
Encourage NLM Partnerships
NLM's outreach programs are essential to MLA and AAHSL membership
and to the profession. Through the National Network of Libraries of
Medicine (NN/LM), with over 6,000 members in communities nationwide,
these activities educate medical librarians, health professionals and
the general public about NLM's services and train them in the most
effective use of these services. The NN/LM promotes educational
outreach for public libraries, secondary schools, senior centers and
other consumer-based settings, and its emphasis on outreach to
underserved populations helps reduce health disparities among large
sections of the American public. NLM's ``Partners in Information
Access'' program improves access by local public health officials to
information which prevents, identifies and responds to public health
threats and ensures every public worker has electronic health
information services that protect the public's health.
NLM's MedlinePlus provides consumers with trusted, reliable health
information on more than 900 topics in English and Spanish. It has
become a top destination for those seeking information on the Internet,
attracting more than 1.2 million visitors daily. NLM has continued to
make enhancements to MedlinePlus, with selected materials now available
in forty other languages. Other products and services that benefit
public health and wellness include the NIH MedlinePlus Magazine and NIH
MedlinePlus Salud, available in doctors' offices nationwide, and NLM's
MedlinePlus Connect--a utility which enables clinical care
organizations to implement links from their electronic health records
systems to relevant patient education materials in MedlinePlus.
MLA and AAHSL applaud the success of NLM's outreach initiatives,
and we look forward to continuing to work with NLM on these programs.
Emergency Preparedness and Response
Through its Disaster Information Management Research Center, NLM
collects and organizes disaster-related health information, ensures
effective use of libraries and librarians in disaster planning and
response, and develops information services to assist responders. NLM
responds to specific disasters worldwide with specialized information
resources appropriate to the need, including information on
bioterrorism, chemical emergencies, fires and wildfires, earthquakes,
tornadoes, and pandemic disease outbreaks. MLA and NLM continue to
develop the Disaster Information Specialization (DIS) program to build
the capacity of librarians and other interested professionals to
provide disaster-related health information outreach. Working with
libraries and publishers, NLM's Emergency Access Initiative makes
available free full-text articles from hundreds of biomedical journals
and reference books for use by medical teams responding to disasters.
MLA and AAHSL ask the Subcommittee to support NLM's role in this
crucial area which ensures continuous access to health information and
use of libraries and librarians when disasters occur.
Health Information Technology and Bioinformatics
For more than 40 years, NLM has supported informatics research,
training and the application of advanced computing and informatics to
biomedical research and healthcare delivery including telemedicine
projects. Many of today's biomedical informatics leaders are graduates
of NLM-funded informatics research programs at universities nationwide.
A number of the country's exemplary electronic and personal health
record systems benefit from findings developed with NLM grant support.
The importance of NLM's work in health information technology
continues to grow as the Nation moves toward more interoperable health
information technology systems. A leader in supporting the development,
maintenance, and dissemination of standard clinical terminologies for
free nationwide use (e.g., SNOMED), NLM works closely with the Office
of the National Coordinator for Health Information Technology to
promote the adoption of interoperable electronic records, and has
developed tools to make it easier for EHR developers and users to
implement accepted health data standards in their systems.
Organizational Bios
The Medical Library Association (MLA) is a nonprofit, educational
organization with 4,000 health sciences information individual and
institutional members. Founded in 1898, MLA provides lifelong
educational opportunities, supports a knowledge base of health
information research, and works with a network of partners to promote
the importance of quality information for improved health to the
healthcare community and the public.
The Association of Academic Health Sciences Libraries (AAHSL)
supports academic health sciences libraries and directors in advancing
the patient care, research, education and community service missions of
academic health centers through visionary executive leadership and
expertise in health information, scholarly communication, and knowledge
management.
Thank you again for the opportunity to present our views. We look
forward to continuing this dialogue and supporting the Subcommittee's
efforts to secure the highest possible funding level for NLM in fiscal
year 2015 and the years beyond to support the Library's mission and
growing responsibilities. Information about NLM and its programs can be
found at http://www.nlm.nih.gov.
______
Prepared Statement of the Mesothelioma Applied Research Foundation
Chairman Harkin, Ranking Member Moran and Members of the
Subcommittee, thank you for the opportunity to provide written
testimony on behalf of the mesothelioma community. My name is Mary
Hesdorffer and I am the Executive Director of the Mesothelioma Applied
Research Foundation. I am testifying on behalf of the mesothelioma
community composed of patients, physicians, caregivers and family
members. I am a Nurse Practitioner with over sixteen years' experience
working with mesothelioma patients in the clinical setting. I would
like to use this opportunity to emphasize the great need for increased
funding for the National Institutes of Health (NIH), including the
National Cancer Institute (NCI), both of which play a critical role in
improving treatment for mesothelioma.
Mesothelioma is an aggressive cancer known to be caused by exposure
to asbestos. Doctors say it is among the most painful of cancers, and
the prognosis is poor even with the best available treatment.
The harsh reality for patients with malignant mesothelioma is that
it is a terminal illness; the five-year survival rate is five to ten
percent, making it one of the most deadly cancers. Left untreated,
survival ranges from six to 9 months, and if treated with the sole Food
and Drug Administration (FDA) approved therapy, median survival is only
12.3 months.
With only one FDA approved treatment available, mesothelioma
patients must take a trial and error approach to treatment, making
agonizing decisions each step of the way. Most patients must make the
tough decision to go into a clinical trial, use off label treatments,
or undergo drastic surgeries knowing they may see no benefit
whatsoever. They choose to do this with a powerful hope they can help
doctors learn how to treat mesothelioma, possibly live a while longer
and prevent future mesothelioma patients from enduring the same
difficult experience.
Fortunately, there are brilliant researchers dedicated to
mesothelioma. The Mesothelioma Applied Research Foundation has made a
significant investment, funding a total of $8.7 million to support
research in hopes of giving researchers the first seed grant they need
to get started. We need the continued partnership with the Federal
Government to develop the promising findings into effective treatments.
In research, innovative and personalized therapies from the mapping
of the human genome or those that utilize the body's own immune system
are becoming a reality for mesothelioma. These developments have the
potential to reduce the human toll of mesothelioma, but need continued
research funding to bring the advances from the bench to the bedside.
Recent research findings have linked mesothelioma to a germline
mutation in the BAP1 gene and a somatic mutation in the NF2 gene.
Currently, the research goal of the BAP1 and NF2 genes is for
prevention and early detection of mesothelioma. For example,
individuals known to be exposed to asbestos who carry this gene can be
studied to determine if a cancer signal can be picked up before the
development of mesothelioma. The idea is that if you have a germ line
mutation, you and your immediate family will be screened for cancers
associated with this gene in the hope of picking up an early
malignancy. Also, researchers will study ways to turn off this gene, if
defective. There is great potential in these findings.
Immunotherapy is another exciting area of research. An
immunotherapy is a treatment that uses certain parts of a person's
immune system to target cancer, and is one of the most exciting areas
in cancer research. Dr. Raffit Hassan at the NCI and his collaborators
have shown that mesothelin, a tumor antigen which was discovered at the
NCI, is a useful target for tumor-specific therapy of malignant
mesothelioma. His group is presently conducting clinical trials of
three different agents targeting mesothelin. Namely, SS1P which is an
anti-mesothelin immunotoxin, MORAb-009 which is a chimeric anti-
mesothelin monoclonal antibody and CRS-207 which is a mesothelin tumor
vaccine. They have seen some success, and it has given patients a
reason to be optimistic.
It is efforts like these that give mesothelioma patients hope. I am
grateful for the Federal Government's investment in mesothelioma
research and I want to see it continued and increased. Unless
researchers have the funds to continue, these discoveries will not
yield improved treatments, patients will run out of options and
continue to die from this disease.
Cancer research funding as a share of the NIH budget has declined
while the scientific and public health need has gone up. In the late
1990s, NCI's budget made up 18.7 percent of the NIH budget. Today, it
is 16.4 percent of the NIH budget . That decline has reduced NCI's
funding by $680 million below what it would have received in fiscal
year 2014 if its share of NIH's total budget had been maintained.
The mesothelioma community asks that the Subcommittee recognize the
National Institutes of Health (NIH) as a critical national priority by
providing at least $32 billion, including $5.26 Billion for the
National Cancer Institute in funding in the fiscal year 2015 Labor-HHS-
Education Appropriations bill. This funding recommendation represents
the minimum investment necessary to avoid further loss of promising
research and at the same time allows the NIH's budget to keep pace with
biomedical inflation.
I look to the Labor, Health and Human Services, Education and
Related Agencies Appropriations Subcommittee to provide continued
leadership and hope to the people who develop this fatal cancer. Thank
you for the opportunity to submit testimony and for funding the
National Institutes of Health and the National Cancer Institute at the
highest possible level.
About the Mesothelioma Applied Research Foundation:
The Mesothelioma Applied Research Foundation is the nonprofit
collaboration of patients and families, physicians, advocates, and
researchers dedicated to eradicating the life-ending and vicious
effects of mesothelioma. We believe in a cure for mesothelioma. Given
the human toll of suffering the disease causes, the compassion and
energy of the mesothelioma community, the moral, legal and economic
aspects of asbestos, and the benefits of mesothelioma research to
cancer research generally, we believe that the resources to accomplish
this cure are available and must be mobilized. We seek to marshal and
utilize these resources responsibly, as effectively as possible, with
financial transparency and by adhering to health policy guidelines that
foster ethical clinical and administrative practices, and ethical
decisionmaking to:
--Offer hope and support to patients and families by educating them
on the disease, helping them to obtain the most up-to-date
information on treatment options and to connect with
mesothelioma treatment specialists, and providing them
assistance, emotional support and community with others;
--Fund the highest quality and most promising mesothelioma research
projects from around the world through rigorous peer-review;
and
--Raise awareness of mesothelioma, and advocate that the public and
private sectors partner in the effort to cure it by directing
the resources needed to stop this global tragedy
______
Prepared Statement of the National AHEC Organization
The members of the National AHEC Organization (NAO) are pleased to
submit this statement for the record recommending $75 million in fiscal
year 2015 for the Area Health Education Center (AHEC) Program
authorized under Title VII of the Public Health Service Act and
administered through the Health Resources and Services Administration
(HRSA) at the Department of Health and Human Services.
The NAO is the professional organization representing AHECs. The
AHEC Program is an established and effective national primary care
training network built on committed partnerships of 53 medical schools
and academic centers. Additionally, 253 AHEC centers within 48 States
and tens of thousands of community practitioners are affiliated with
the AHEC's national clinical training network.
AHEC is one of the Title VII Health Professions Training programs,
originally authorized at the same time as the National Health Service
Corps (NHSC) to create a complete mechanism to provide primary care
providers for Community Health Centers (CHCs) and other direct
providers of healthcare services for underserved areas and populations.
The plan envisioned by creators of the legislation was that the CHCs
would provide direct service. The NHSC would be the mechanism to fund
the education of providers and supply providers for underserved areas
through scholarship and loan repayment commitments.
The AHEC program would be the mechanism to recruit providers into
primary healthcareers, diversify the workforce, and develop a passion
for service to the underserved in these future providers, i.e. Area
Health Education Centers are the workforce development, training and
education machine for the Nation's healthcare safety-net programs. The
AHEC program is focused on improving the quality, geographic
distribution and diversity of the primary care healthcare workforce and
eliminating the disparities in our Nation's healthcare system.
AHECs develop and support the community based training of health
professions students, particularly in rural and underserved areas. They
recruit a diverse and broad range of students into healthcareers, and
provide continuing education, library and other learning resources that
improve the quality of community-based healthcare for underserved
populations and areas.
The Area Health Education Center program is effective and provides
vital services and national infrastructure. Nationwide, over 379,000
students have been introduced to healthcareer opportunities, and over
33,000 mostly minority and disadvantaged high school students received
more than 20 hours each of healthcareer exposure. Over 44,000 health
professions students received training at 17,530 community-based sites,
and furthermore; over 482,000 health professionals received continuing
education through AHECs. AHECs perform these education and training
services through collaborative partnerships with Community Health
Centers (CHCs) and the National Health Service Corps (NHSC), in
addition to Rural Health Clinics (RHCs), Critical Access Hospitals,
(CAHs), Tribal clinics and Public Health Departments.
Justification for Recommendations
The AHEC network is an economic engine that fuels the recruitment,
training, distribution, and retention of a national health workforce.
AHEC stands for JOBS.
--AHECs are critical in the recruitment, training, and retention of
the primary care workforce.
--Research has demonstrated that the community-training network is
the most effective recruitment tool for the health professions
and those who teach remain longer in underserved areas and
communities.
--AHECs are in almost every county in the United States.
--With the aging and growing population, the demand for primary care
workforce is far outpacing the supply.
--AHECs continue to educate and train current workforce, as well as
recruiting and preparing future workforce
--In 2012, AHEC's trained 476,585 Health Professionals in 48 States
in 13,842 Health Professions Shortage Areas (HPSAs)--26.4
percent of those trained were physicians (125,818).
--In 2012, the AHEC's introduced nearly 403,000 students to the
healthcareers professions and workforce from grades K-College.
--The AHEC network's outcomes are the backbone of the Nation's
community-based health professions training, with a focus on
training primary care workforce.
--Continued funding for the AHEC program is necessary as demonstrated
by 1) a growing unmet need for primary care doctors in rural
areas, and 2) the use of the national network of AHEC programs
to carry out administrative priorities.
1. The National Health Service Corps (NHSC), has been mentioned
as a program that addresses the priority of increasing
diversity in the health professions workforce in
underserved and rural areas and addresses the end of the
pipeline. The AHEC program engages in pre-pipeline,
pipeline, and post-pipeline activities that works to move
individuals through a healthcareers pathway and beyond,
with a special focus on primary care doctors.
2. The national network of the AHEC program has been tasked with:
-- Training 13,000+ providers nationwide in OIF/OEF/OND Veteran's
behavioral and mental health, substance abuse, traumatic
brain injury and post-traumatic stress, for those not
utilizing the VA system
-- Working with the Food and Drug Administration to educate
healthcare professionals nationwide on proper opioid
prescribing habits to address the epidemic of prescription
drug abuse
-- HRSA has encouraged functional linkage between Bureau of
Primary Care and Bureau of Health Professions Programs.
AHECs have partnerships with over 1,000 Community Health
Centers nationally to recruit, train, and retain health
professionals who have the cultural and linguistic skills
to serve in HRSA designated underserved areas
-- Affordable Care Act activities such as increasing the
enrollment of individuals, training community health
workers, and educating providers nationwide on health
insurance exchanges
[This statement was submitted by Rob Trachtenberg, Executive
Director, National AHEC Organization.]
______
Prepared Statement of the National Alliance for Eye and Vision Research
executive summary
The National Alliance for Eye and Vision Research (NAEVR) requests
fiscal year 2015 NIH funding of $32 billion, which would fully restore
the $1.7 billion fiscal year 2013 sequester cut partially restored in
fiscal year 2014 and enable an inflationary increase-the NIH has lost
22 percent of its purchasing power since fiscal year 2003, in terms of
constant dollars-and provide for modest growth. This request improves
on the President's proposal to increase NIH funding by only $200
million over fiscal year 2014 and which also increases the Program
Evaluation Transfer to 3 percent, effectively reducing NIH's increase
by $150 million. fiscal year 2015 NIH funding of $32 billion is an
important step toward consistent and sustained funding increases which
are necessary to build upon past investment that has created an
unprecedented scientific opportunity in biomedical research.
--$32 billion NIH funding is critical for supporting Research Project
Grants, as the number of RPGs awarded in fiscal year 2013 was
20 percent less than in fiscal year 2003. R01s, or
investigator-initiated grants, have been affected even more
dramatically, as the number awarded fell by 24 percent between
fiscal year 2003 and fiscal year 2013.
--NIH-funded basic and clinical research has helped to understand the
basis of disease, thereby resulting in innovations in
healthcare to save and improve lives. Its research serves an
irreplaceable role the private sector could not duplicate.
--As an economic driver, in fiscal year 2011NIH-funded research
supported 432,000 jobs across the United States and generated
more than $62 billion in new economic activity. Every $1 of NIH
funding generates $2.21 in local economic growth.
NAEVR requests National Eye Institute (NEI) funding at $730
million, concomitant with $32 billion NIH funding. The President's
budget proposes a minimal NEI increase of $0.9 million or 0.15 percent,
based on its fiscal year 2014 operational net of $675 million-not its
$682 million appropriation. This is unacceptable since NEI has lost 25
percent of its purchasing power since fiscal year 2003, and the fiscal
year 2013 sequester has already resulted in NEI awarding 30 fewer
grants-any one of which may have held the promise to save sight and
restore vision.
As NEI's Budget Decreases, the Incidence of Eye Disease and Vision
Impairment Increases, As Does the Associated Cost, Estimated at
$139 Billion Annually in the United States
Although the fiscal year 2013 sequester cut reduced NEI's budget by
$36 million to $662 million, $20 million of that was restored in fiscal
year 2014 through an appropriation of $682 million. In each year,
however, NEI's appropriation was reduced even further by $5.6 million
and $6.9 million to operational nets of $657 million and $674 million,
respectively, due to the transfer back to the NIH Office of AIDS
Research (OAR) for funding of the dissolved NEI-sponsored Ocular
Complications of AIDS studies. Although OAR's funding to NEI was not
committed into perpetuity, its return to NIH Central effectively
reflects a cut in NEI funding and results in a new baseline upon which
future funding will be based. For example, the President's fiscal year
2015 budget request bases its 0.15 percent NEI increase on the fiscal
year 2014 operational net of $674 million, which results in just a $0.9
million increase in NEI funding to $675 million.
The funding nets described above are well below NEI's highest
appropriation-that of $707 million in fiscal year 2010 (prior to
addition of American Recovery and Reinvestment Act (ARRA) funding.
Unfortunately, as NEI funding has decreased, the challenges it faces
have grown, due to dramatic increases in the incidence and cost of
vision impairment and eye disease.
The NEI estimates that more than 38 million Americans age 40 and
older experience blindness, low vision, or an age-related eye disease
such as age-related macular degeneration (AMD), glaucoma, diabetic
retinopathy, or cataracts. This is expected to grow to more than 50
million Americans by year 2020. Much of this is being driven by the
aging of the population, for example, the ``Silver Tsunami'' of the 78
million baby boomers who will turn age 65 this decade and experience
the greatest risk for eye disease. Other demographic changes are also
contributing to NEI's challenges, for example, African Americans and
Hispanics which increasingly account for a larger share of the U.S.
population and who experience a disproportionately greater prevalence
of eye disease. Vision loss can also be a co-morbid condition of
chronic disease, such as diabetes, which is at epidemic levels due to
the increased incidence of obesity.
In June 2013, Prevent Blindness America, in conjunction with the
National Opinion Research Center at the University of Chicago, released
updated estimates of the cost of vision disorders. NORC estimates the
annual costs of vision disorders at $139 billion annually, inclusive of
direct and indirect costs. Most importantly, the direct medical costs
associated with vision disorders are the fifth highest-only less than
heart disease, cancers, emotional disorders, and pulmonary conditions.
NEI's fiscal year 2014 operational net funding of $674 million, as
well as the President's fiscal year 2015 proposed funding of $675
million, are each less than 0.5 percent of this $139 billion annual
vision disorder cost burden. The U.S. is spending only $2.10 per-
person, per-year for vision research at the NEI, while NORC estimates
that the cost of treating low vision and blindness is $6,690 per-
person, per-year.
In 2009, Congress spoke volumes in passing S. Res 209 and H. Res.
366, which designated 2010-2020 as The Decade of Vision and recognized
NEI's 40th anniversary as the lead institute in funding research to
save sight and restore vision. With the fiscal year 2015 LHHS spending
bill, Congress can act upon its past resolutions regarding vision and
ensure that NEI is adequately funded to meet these challenges.
$730 million fiscal year 2015 funding enables nei to pursue its primary
``audacious goal'' of restoring vision
NEI has lost 25 percent of its purchasing power since fiscal year
2003. The fiscal year 2013 sequester cut resulted in NEI awarding 30
fewer grants, and the President's fiscal year 2015 proposal would
result in 23 fewer awards. Any one of those missed funding
opportunities could have held the promise to save sight and restore
vision-goals that would have seemed unattainable just a few short years
ago. The NEI has long been a leader in biomedical research. As NIH
Director Francis Collins, M.D., Ph.D. stated in February 2013:
``It's often, it seems to me, that vision research is a couple of
steps in front of things that are happening in biomedical research.
It's clear that vision research has played a disproportionately large
share in scientific breakthroughs.''
Dr. Collins made his comments at NEI's Audacious Goals Development
meeting, where more than 200 attendees reflecting every sector of the
vision community, including government scientists and regulators from
various disciplines, discussed topics built around the ten winning
submissions from a pool of nearly 500 entries selected through NEI's
Audacious Goals in Vision Research and Blindness Rehabilitation
Challenge. This initiative, conducted by NEI with its National Advisory
Eye Council (NAEC) and through The America Competes Act, yielded such
ideas as restoring light sensitivity to the blind through gene-based
therapies and visual prosthetics, pinpoint correction of defective
genes, and growing healthy tissue from stem cells for ocular tissue
transplants.
In consultation with the NAEC, the NEI converged on its primary
Audacious Goal for vision research: To Regenerate Neurons and Neuronal
Connections in the Eye and Visual System.'' As NEI Director Paul
Sieving, M.D., Ph.D. stated in February 2014:
``The goals are bold but achievable. They are beyond what medicine
currently can do. We are planning for a 10-12-15 year effort to reach
these endpoints. Success would transform life for millions of people
with eye and vision diseases. It would have major implications for
medicine of the future, for vision diseases, and even beyond this, for
neurological diseases.''
As NEI works to achieve this goal, it will build upon its
breakthrough research funded through past Federal investment. For
example, NEI has been a leader in determining the genetic basis of
disease-the research it has funded has identified more than 500 genes
associated with both common and rare eye diseases, which is 7.5 percent
of all disease-causing genes discovered to-date. Understanding the
genetic basis of the disease and underlying mechanisms will lead to
better diagnostics and therapies. Since last year's testimony, NEI has
announced that:
--The AMD Gene Consortium, a network of international investigators
representing 18 research groups, has discovered seven new
regions of the human genome-called loci-that are associated
with increased risk of AMD. They also confirmed 12 loci already
identified in previous studies. These loci implicate a variety
of biological functions, including regulation of the immune
system, maintenance of cellular structure, growth and
permeability of blood vessels, lipid metabolism, and
atherosclerosis. AMD is the leading cause of vision loss
overall, as well as the leading cause in individuals are 60-
plus.
--The NEI Glaucoma Human Genetics Collaboration (NEIGHBOR)
Consortium, which involves clinicians and geneticists at
multiple institutions throughout the U.S. who are studying
genetic variants associated with Primary Open Angle Glaucoma-
the most common form of the disease-has identified the first
common genetic risk factors for normal pressure glaucoma.
NEIGHBOR, unique because it is the largest Genome-Wide
Association Study to-date, will generate new insights into the
molecular pathogenesis, effective screening and prevention
strategies, and more rational treatment approaches for this
disease. Glaucoma is three-to-four times more prevalent in
African Americans than non-Hispanic Whites and is the leading
cause of blindness in the Latino population.
These are ambitious goals that require increased-not decreased-
funding. Our Nation's investment in vision health is an investment in
its overall health. NEI's breakthrough research is a cost-effective
investment, since it is leading to treatments and therapies that can
ultimately delay, save, and prevent health expenditures, especially
those associated with the Medicare and Medicaid programs. It can also
increase productivity, help individuals to maintain their independence,
and generally improve the quality of life, especially since vision loss
is associated with increased depression and accelerated mortality.
The very health of the vision research community is also at stake
with the decrease in NEI funding. Not only will funding for new
investigators be at risk, but also that of seasoned investigators,
which threatens the continuity of research and the retention of trained
staff, while making institutions more reliant on bridge and
philanthropic funding. .
about naevr
NAEVR, which serves as the ``Friends of the NEI,'' is a 501(c)4
non-profit advocacy coalition comprised of 55 professional
(ophthalmology and optometry), patient and consumer, and industry
organizations involved in eye and vision research. Visit NAEVR's Web
site at www.eyeresearch.org.
______
Prepared Statement of the National Alliance on Mental Illness
Chairman Harkin and members of the Subcommittee, I am Mary
Giliberti, Executive Director of NAMI (the National Alliance on Mental
Illness). I am pleased today to offer NAMI's views on the
Subcommittee's upcoming fiscal year 2015 bill. The National Alliance on
Mental Illness (NAMI) is the Nation's largest grassroots advocacy
organization representing persons living with serious mental illness
and their families. Through our 1,100 affiliates in all 50 States, we
support education, outreach, advocacy and research on behalf of persons
with serious mental illness such as schizophrenia, manic depressive
illness, major depression, severe anxiety disorders and mental health
conditions affecting children.
An estimated 11.5 million American adults live with a mental
illness, such as schizophrenia, bipolar disorder, and major depression.
Based on estimates for 2010, mental disorders accounted for 21.3percent
of all years lived with disability in the United States. Among the top
20 causes of years lived with disability, five were mental disorders:
major depressive disorder (8.3 percent of the total), anxiety disorders
(5.1 percent), schizophrenia (2.2 percent), bipolar disorder (1.6
percent) and dysthymia (1.5 percent). Suicide is the 10th leading cause
of death in the U.S., accounting for the loss of more than 38,000
American lives each year, more than double the number of lives lost to
homicide. The social and economic costs associated with these disorders
are tremendous. A cautious estimate places the direct and indirect
financial costs associated with mental illness in the U.S. at well over
$300 billion annually, and it ranks as the third most costly medical
condition in terms of overall healthcare expenditure, behind only heart
conditions and traumatic injury.
These costs are not only financial, but also human in terms of lost
productivity, broken families and lives lost to suicide. Investment in
mental illness research and services are--in NAMI's view--the highest
priority for our Nation and this Subcommittee.
National Institute of Mental Health Research Funding
As a member of the Ad Hoc Group for Medical Research Funding, NAMI
supports a $32 billion overall allocation for the National Institutes
of Health (NIH). This increase is needed to avoid having our country
continue to fall behind China, India and other emerging Nations in
terms of our public investment in scientific research. As you know, the
President is requesting a $23 million increase for the National
Institute of Mental Health (NIMH) for fiscal year 2015, boosting
funding for the agency to $1.44 billion. NAMI would urge the
Subcommittee to fund investments beyond this amount with an overall
higher allocation for the entire NIH.
NAMI also supports the President's BRAIN Initiative (Brain Research
through Advancing Innovative Neurotechnologies) and the request for a
$40 million boost, up to $100 million. The BRAIN Initiative is multi-
agency collaborative with a number of foundations designed to unleash
new technologies and undertake basic mapping of circuits and neurons in
the most complex organ in the human body.
Accelerating the Pace of Psychiatric Drug Discovery
In NAMI's view, there is an urgent need for new medications to
treat serious mental illness. Existing medications can be helpful, but
they often have significant limitations; in some cases requiring weeks
to take effect; failing to relieve symptoms in a significant proportion
of patients; or, resulting in debilitating side effects. However,
developing new medications is a lengthy and expensive process. Many
promising compounds fail to prove effective in clinical testing after
years of preliminary research. To address this urgent issue, NAMI is
encouraging NIMH to accelerate the pace of drug discovery through an
`experimental medicine' approach to evaluate novel interventions for
mental illnesses. This ``fast-fail'' strategy is designed not only to
quickly identify candidates that merit more extensive testing, but also
to identify targets in the brain for the development of additional
candidate compounds. Through small trials focused on proof-of-concept
experimental medicine paradigms, we can make progress to demonstrate
target engagement, safety, and early signs of efficacy.
Advancing Services and Intervention Research
NAMI enthusiastically supports the NIMH Recovery After an Initial
Schizophrenia Episode (RAISE) Project, aimed at preventing the long-
term disability associated with schizophrenia by intervening at the
earliest stages of illness. The RAISE Early Treatment Program (RAISE
ETP) will conclude this year. The RAISE Connection Program has
successfully integrated a comprehensive early intervention program for
schizophrenia and related disorders into an existing medical care
system. This implementation study is now evaluating strategies for
reducing duration of untreated psychosis among persons with early-stage
psychotic illness. When individuals with schizophrenia and bipolar
disorder progress to later stages of their illness, they become more
likely to develop--and die prematurely--from medical problems such as
heart disease, diabetes, cancer, stroke, and pulmonary disease than
members of the general population. NIMH funded research is
demonstrating progress advancing the health of people with serious
mental illness. NIMH needs to advance this research to large-scale
clinical trials aimed at reducing premature mortality for people living
with serious mental illness.
Investing in Early Psychosis Prediction and Prevention (EP3)
As many as 100,000 young Americans experience a first episode of
psychosis (FEP) each year. The early phase of psychotic illness is a
critical opportunity to alter the downward trajectory and social,
academic, and vocational challenges associated with serious mental
illness such as schizophrenia. The timing of treatment is critical;
short- and long-term outcomes are better when individuals begin
treatment close to the onset of psychosis. Unfortunately, the majority
of people with mental illness experience significant delays to seeking
care--up to 9 years in some cases. Such delays result in periods of
increased risk for poor outcomes, especially suicide.
NIMH-funded research has focused on the prodrome, the high-risk
period preceding the onset of the first psychotic episode of
schizophrenia. Through North American Prodrome Longitudinal Study
(NAPLS) and other studies focused on early prediction and prevention of
psychosis, NIMH has launched Early Psychosis Prediction and Prevention
(EP3) initiative. EP3 is showing promise in detecting risk States for
psychotic disorders and reducing the duration of untreated psychosis in
adolescents that have experienced FEP.
Advancing Precision Medicine
NAMI supports efforts at NIMH to translate basic research findings
on brain function into more person-centered and multifaceted diagnoses
and treatments for mental disorders. The Research Domain Criteria
(RDoC) is showing promise toward efforts to build a classification
system based more on underlying biological and basic behavioral
mechanisms than on symptoms, RDoC should begin to give us the precision
currently lacking with traditional diagnostic approaches to mental
disorders.
Funding for Programs at SAMHSA's Center for Mental Health Services
As noted above, the costs of untreated mental illness to our Nation
are enormous--as high as $300 billion when taking into account lost
wages and productivity and other indirect costs. These costs are
compounded by the fact that across the Nation States and localities
devote enormous resources addressing the human and financial costs
untreated mental illness through law enforcement, corrections, homeless
shelters and emergency medical services. This phenomenon of ``spending
money in all the wrong places'' is tragic given that we have a vast
array of proven evidence-based interventions that we know work--
assertive community treatment, supported employment, family psycho-
education and supportive housing.
NAMI supports programs at the Center for Mental Health Services
(CMHS) at SAMHSA that are focused on replication and expansion of these
evidence-based practices that serve children and adults living with
serious mental illness. The most important of these programs is the
Mental Health Block Grant (MHBG). NAMI is extremely grateful for the
increases in funding for the MHBG that this Subcommittee has made in
recent years, boosting funding from $420 million in fiscal year 2010,
up to its current level of $484 million in fiscal year 2014. This
increase has been important to helping States fills gaps in services
that have occurred as States cut more than $4 billion from State mental
health budgets since the recession began in 2008.
NAMI also supports the 5 percent set aside in the in the MHBG that
this Subcommittee enacted in fiscal year 2014 for early intervention in
psychosis. As noted above, the NIMH RAISE study validated the most
effective approaches for providing coordinated care for adolescents
experiencing FEP. Among these is Coordinated Specialty Care (CSC), a
collaborative, recovery-oriented approach that emulates the assertive
community treatment combining evidence-based services into an effective
package. CSC emphasizes shared decisionmaking--which NAMI strongly
supports--with the recipient of services taking an active role in
determining treatment preferences and recovery goals.
In April, CMHS issued guidance to the States specifying that
funding as part of the 5 percent set aside must be used for those who
have developed the symptoms of early serious mental illness, not for
``preventive intervention for those at high risk of serious mental
illness.'' NAMI supports this guidance and we recommend that the
Subcommittee continue this 5 percent set aside for FEP in fiscal year
2015 and beyond.
NAMI would also recommend the following priorities for CMHS for
fiscal year 2015:
--Continuation of the Children's Mental Health program at $117
million, and
--Support the President's proposal for a $6 million increase for
suicide prevention activities at CMHS (up to $54.2 million),
including funding for the Garrett Lee Smith Memorial Act.
Addressing Early Mortality and Serious Mental Illness, Integrating
Primary and Behavioral Health Care
The CMHS Primary Behavioral Health Care Integration (PBHCI) program
supports community behavioral health and primary care organizations
that partner to provide essential primary care services to adults with
serious mental illnesses. Because of this program, more than 33,000
people with serious mental illness and substance use disorders are
screened and treated at 100 grantee sites for diabetes, heart disease,
and other common and deadly illnesses in an effort to stem the alarming
early mortality rate from these health conditions in this population.
NAMI urges the Subcommittee to fund the PBHCI for fiscal year 2015 at
$50 million.
Addressing the Needs of Homeless Individuals Living with Serious
Mental Illness
On any given night, according to 2013 data, 610,042 people are
homeless, and 15 percent of these individuals are defined as long-term
or chronically homeless. Years of reliable data and research
demonstrate that, for single individuals with serious mental illness
who live with complex needs, the most successful intervention for
ending and preventing homelessness is linking housing to appropriate
support services. Although there is a need for more affordable housing,
funding the supportive services is even more difficult. SAMHSA homeless
programs fill a gap created by a preference of HUD to fund housing
rental assistance and capital needs. HHS must take responsibility to
fund the critically important services that are necessary for programs
to be effective.
In 2013, SAMHSA was not able to award any new community-based
services grants. For the first time, eleven States (AZ, GA, HI, WA, LA,
IL, NV, PA, MA, MI and CO) did receive funding to improve statewide
alignment of resources but every State could use SAMHSA assistance in
their efforts to end homelessness. Over the years, hundreds of
government entities and local providers have been unable to move
forward with important work due to inadequate funding levels. The
current fiscal year 2014 funding level of SAMHSA homeless programs is
$74 million, divided between CMHS and CSAT. NAMI supports an increase
for this joint program up to $100 million, equally divided between CMHS
and CSAT.
NAMI also supports funding for the PATH program (Projects for
Assistance in Transition from Homelessness) that allocates funds by
formula to States to serve homeless people with serious mental illness.
Eligible services include outreach, screening and diagnosis,
habilitation and rehabilitation, community mental health services,
substance abuse treatment, case management, residential supervision,
and housing. PATH supported programs reached over 191,839 people in
fiscal year 2013. Of these, 65 percent were unsheltered at the time of
engagement, 42 percent were not engaged in mental illness treatment and
53 percent had co-occurring substance use disorders. NAMI recommends at
least $75 million for the PATH program for fiscal year 2015 (the
authorized amount). In fiscal year 2014, the PATH program is funded at
$65 million.
Conclusion
Chairman Harkin, thank you for the opportunity to share NAMI's
views on the Labor-HHS-Education Subcommittee's fiscal year 2015 bill.
NAMI's consumer and family membership thanks you for your leadership on
these important national priorities.
[This statement was submitted by Mary Giliberti, Executive
Director, National Alliance on Mental Illness.]
______
Prepared Statement of the National Alliance to End Sexual Violence
On behalf of the National Alliance to End Sexual Violence (NAESV)
representing 56 state and territorial sexual assault coalitions and
more than 1300 local rape crisis centers, I am respectfully requesting
fiscal year 2015 Federal funding to support comprehensive rape
prevention and education and direct services for victims of sexual
violence. Specifically, NAESV is requesting $50.6 million, $45 million
for the program and $5.6 million in PHS evaluation tap funds, for the
Rape Prevention & Education Program (RPE) in the Centers for Disease
Control and Prevention's (CDC) National Center for Injury Prevention
and Control budget. In addition, NAESV is requesting level funding of
$160 million for the Preventive Health and Health Services Block Grant,
which includes a $7 million set-aside for rape prevention services, in
CDC's National Center for Chronic Disease Prevention and Health
Promotion budget. Together, we must make our communities safer.
One in five women has been the victim of rape or attempted rape.
Nearly one in two women has experienced some form of sexual violence
and one in five men has experienced a form of sexual violence other
than rape in their lifetime. The CDC National Intimate Partner and
Sexual Violence Survey study confirmed that the impacts of sexual
violence on society are enormous. Over 80 percent of women who were
victimized experienced significant short and long-term impacts related
to the violence such as Post-Traumatic Stress Disorder (PTSD), injury
(42 percent) and missed time at work or school (28 percent). The CDC
report also shows that most rape and partner violence is experienced
before the age of 24, highlighting the importance of preventing this
violence before it occurs.
The 2013 Rape Crisis Center Survey, distributed by NAESV,
demonstrated that over 75 percent of these programs lost funding in the
last year, causing programs to have to reduce services, lay off staff
or even close. Over one third of rape crisis centers reported having a
waiting list for services, with victims waiting most often for
counseling services and support groups. Three out of four programs
cannot meet current requests for community prevention programs. As you
begin the fiscal year 2015 appropriations process, please fund the
following priorities.
Rape Prevention and Education (RPE).--The National Alliance to End
Sexual Violence urges Congress to provide $45 million for the program
and an additional $5.6 million in PHS evaluation tap funds for RPE
program evaluation, with the goal of creating a more extensive evidence
base for sexual violence prevention. Funding for RPE through CDC's
Injury Center provides formula funding to every State and territory to
raise awareness of the problem of sexual assault, support efforts to
prevent first-time perpetration and victimization, and bring together
diverse partners to develop, implement and evaluate statewide sexual
assault prevention plans. The RPE program engages boys and men as
partners, supports interdisciplinary research collaborations, fosters
cross-cultural approaches to prevention, promotes healthy
relationships, and funds the critically important National Sexual
Violence Resource Center. High profile cases have increased the demand
for prevention and education beyond the current capacity of State
sexual assault coalitions and local rape crisis centers. The expansive
media attention also points to the need for comprehensive community
responses to sexual violence like those funded by RPE. With fiscal year
2013 funding, the program educated more than 1.8 million students,
answered 340,000 hotline calls, and conducted over 105,000 trainings
nationwide.
Formula Shortfall.--Beginning in fiscal year 2014, a new RPE
funding formula is being implemented based on VAWA 2013. While the
formula provides a base funding of $150,000 for all 50 States,
Washington, DC and Puerto Rico, and $50,000 for territories, it reduces
the funding provided to large States. In addition, CDC is altering the
fiscal year of the program which results in reduced funding stretched
over a span of 15 months, further penalizing State coalitions and local
rape crisis centers at the same time demand for rape prevention and
education is increasing due to high profile cases causing alarm in
local communities. Increased funding is required to avoid critical
shortfalls.
Program Evaluation.--There is a need to increase the evidence base
for sexual violence prevention. However, those efforts should be funded
by additional funding--not from program funds to States and local rape
crisis centers. Most recently, CDC decided to make ``State level
evaluation'' mandatory despite many States starting local, regional or
targeted evaluation efforts. It is the CDC's stated perspective that
this would be ``less labor intensive.'' However, this strategy forces
everyone down one path, without a recognition of the work and progress
that is currently underway in many States, nor of each State's
individual goals, projects or bandwidth to accomplish the work. To
date, CDC has not demonstrated that they have developed any significant
sexual violence specific research and evaluation over the years.
Rather, all indicators suggest that they are relying on proxy measures
that have been developed for other issues such as alcohol use, which
are not suited to measure sexual violence. We support the CDC proposal
to use PHS evaluation tap funding for this purpose. We do not want
program funds diverted from the communities at a time when demand for
prevention and education, as well as services, is increasing at such a
rapid rate.
Preventive Health & Health Services Block Grant (PHHSBG).--We are
very grateful for the fiscal year 2014 funding of $160 million enacted
by Congress and disappointed with the Administration's efforts to
eliminate the program which provides much needed resources to
communities. The Public Health Service Act of 2010 authorizes the block
grant (CDC, Chronic Disease) and provides a rape set-aside provision
which guarantees at least $7 million for rape services and prevention.
Please retain the block grant funding that supports local rape crisis
centers providing services, statewide training and technical assistance
to increase capacity to assist rape victims and prevent future
victimization. Maximum funding is requested.
We must have the resources to meet the education and prevention
needs in the community. Victims deserve support, our young people
deserve to grow up safely, and research tells us that appropriate and
early intervention and prevention can mitigate the costs and
consequences of sexual violence and prevent that violence from
occurring in the first place. The best way to prevent victimization is
to prevent first time perpetration. The best way to convict a rapist is
to support and advocate for the victim, obtain evidence and provide
assistance and training to law enforcement.
Thank you for the opportunity for the National Alliance to End
Sexual Violence to present testimony for the record as the Senate
Committee on Appropriations Subcommittee on Labor, Health and Human
Services, Education, and Related
Agencies begins the process to prepare the fiscal year 2015
Appropriations Bill. If you need further information, I can be reached
at monika@nccasa.org and www.endsexualviolence.org.
[This statement was submitted by Monika Johnson-Hostler, Board
President, National Alliance to End Sexual Violence.]
______
Prepared Statement of the National Alopecia Areata Foundation
Chairman Harkin and distinguished members of the Subcommittee,
thank you for your time and your consideration of the priorities of the
community of individuals affected by alopecia areata as you work to
craft the fiscal year 2015 Labor, Health and Human Services
Appropriations Bill.
about alopecia areata
Alopecia areata is a prevalent autoimmune skin disease resulting in
the loss of hair on the scalp and elsewhere on the body. It usually
starts with one or more small, round, smooth patches on the scalp and
can progress to total scalp hair loss (alopecia totalis) or complete
body hair loss (alopecia universalis).
Alopecia areata affects approximately 2.1 percent of the
population, including more than 6.5 million people in the United States
alone. The disease disproportionately strikes children and onset often
occurs at an early age. This common skin disease is highly
unpredictable and cyclical. Hair can grow back in or fall out again at
any time, and the disease course is different for each person. In
recent years, scientific advancements have been made, but there remains
no cure or indicated treatment options.
The true impact of alopecia areata is more easily understood
anecdotally than empirically. Affected individuals often experience
significant psychological and social challenges in addition to the
biological impact of the disease. Depression, anxiety, and suicidal
ideation are health issues that can accompany alopecia areata. The
knowledge that medical interventions are extremely limited and of minor
effectiveness in this area further exacerbates the emotional stresses
patients typically experience.
about the foundation
NAAF, headquartered in San Rafael, California, supports research to
find a cure or acceptable treatment for alopecia areata, supports those
with the disease, and educates the public about alopecia areata. NAAF
is governed by a volunteer Board of Directors and a prestigious
Scientific Advisory Council. Founded in 1981, NAAF is widely regarded
as the largest, most influential, and most representative foundation
associated with alopecia areata. NAAF is connected to patients through
local support groups and also holds an important, well-attended annual
conference that reaches many children and families.
Recently, NAAF initiated the Alopecia Areata Treatment Development
Program (TDP) dedicated to advancing research and identifying
innovative treatment options. TDP builds on advances in immunological
and genetic research and is making use of the Alopecia Areata Clinical
Trials Registry which was established in 2000 with funding support from
the National Institute of Arthritis and Musculoskeletal and Skin
Diseases; NAAF took over responsibility financial and administrative
responsibility for the Registry in 2012 and continues to add patients
to it. NAAF is engaging scientists in active review of both basic and
applied science in a variety of ways, including the November 2012
Alopecia Areata Research Summit featuring presentations from the Food
and Drug Administration (FDA) and NIAMS.
deidre's story
It has been 15 years since I first found the bald patch on my head
that would completely change the course of my life. As a student at
Florida State University during my junior year I found a perfectly
round bald patch while blow-drying my very thick long hair--my pride
and joy! Little did I know then the significant effect alopecia areata
would have on my life.
I followed the typical patient profile for this disease. I started
with one patch the size of a 50 cent piece, which later evolved into
patches of varying sizes all over my head, and then to total loss of
all scalp hair, which progressed to the most severe form of the
disease: total loss of all body hair including my scalp, eyebrows,
eyelashes, etc. Recently, my hair has inexplicably started to grow back
in a very patchy and strange fashion on my head, while most of my body
still remains hairless; a perfect example of the completely
unpredictable course of this disease, which can cause significant
emotional turmoil and distress for the sufferer.
As a professional woman, this disease has had a severe impact on my
life. I have to present a confident image to the outside world. Living
in constant fear of being discovered as a bald woman, being thought to
be sick, bizarre, or worse has always been on the forefront of my mind.
The exorbitant cost for treatments such as cortisone injections,
extremely painful with questionable efficacy, has been an issue for me
along with the expensive cranial prosthetics. Over the course of the
years these have cost me thousands of dollars. If a lawyer like myself
has financial difficulty when it comes to paying for treatments and
prosthetics (which are not covered by insurance due to lack of CMS
coverage benefits for those with Alopecia Areata), can you imagine the
plight facing those patients that live on limited or fixed income?
The fact that there is so little known about the causes or possible
treatments/cure for this disease only adds to the pain and suffering.
This is a disease that alters the way you see yourself and the way the
outside world treats you, and also causes significant and often
debilitating emotional distress. The fact that there is little that can
currently be done adds to that pain and suffering. Patients face a
bleak outlook. For me, it has been a constant battle. I have not lived
a single moment in the 5,475 days since that I have not looked in the
mirror and wanted to scream or cry, not a single day that I haven't
thought that I am damaged, abnormal, or ugly because of my hair loss,
not a single day that I haven't worried about how a client, colleague,
friend, or love-interest might see and judge me. Many will say to me
that ``it is only hair'' or ``at least it's not cancer.'' These
comments only frustrate and upset me more. The feelings of being
ostracized as an outcast can become deafening, even for a confident,
intelligent professional. I shudder to think how others who don't
possess my strength of character handle the stresses of this disease.
It is only with additional funding for research that we might hope
to improve the lives of the millions in the U.S. living with alopecia
areata. Few have even heard of the disease. That fact alone creates
additional stresses and difficulties for those of us with the disease,
constantly having to explain what is ``wrong'' with us. Increased
research into viable treatment options and a potential cure could
significantly impact millions of lives, from small children to adults,
facing the constant battle that comes from a total loss of self image
and confidence.
I thank you on behalf of myself and of the entire alopecia areata
community for consideration of NAAF's requests.
sequestration
We have heard from the medical research community that
sequestration and deficit reduction activities have created serious
issues for Federal funding opportunities and the career development
pipeline. In order to ensure that research into alopecia areata, skin,
and autoimmune disorders can continue to move forward, and, more
importantly, to ensure that our country is adequately preparing the
next generation of young investigators, we urge you to avert, mitigate,
or otherwise eliminate the specter of sequestration. While the
Foundation has anecdotal accounts of the harms of sequestration, the
Federated American Societies for Experimental Biology has reported:
--In constant dollars (adjusted for inflation), the NIH budget in
fiscal year 2013 was $6 billion (22.4 percent) less than it was
in fiscal year 2003.
--The number of competing research project grants (RPGs) awarded by
NIH has also fallen sharply since fiscal year 2003. In fiscal
year 2013, NIH made 8,283 RPG awards, which is 2,110 (20.3
percent) fewer than in fiscal year 2003.
--Awards for R01-equivalent grants, the primary mechanism for
supporting investigator-initiated research, suffered even
greater losses. The number awarded fell by 2,528 (34 percent)
between fiscal year 2003 and fiscal year 2013.
The pay line for some NIH funding mechanisms has fallen from 18
percent to 10 percent while the average age for a researcher to receive
their first NIH-funded grant has climbed to 42. These are strong
disincentives to choosing a career as a medical researcher. Our
scaling-back is occurring at a time when many foreign countries are
investing heavily in their biotechnology sectors. China alone plans to
dedicate $300 million to medical research over the next 5 years; this
amount is double the current NIH budget over the same period of time.
Scientific breakthroughs will continue, but America may not benefit
from the return-on-investment of a robust biotechnology sector. For the
purposes of economic and national security, as well as public health,
the Foundation asks that you work with your colleagues to eliminate
sequestration and recommit to supporting this Nation's biomedical
research enterprise.
centers for disease control and prevention
CDC and NCCDPHP are well-positioned to improve our understanding of
alopecia areata through surveillance and surveys. There are many
opportunities in this area due to the fact that alopecia areata is the
most easily observable autoimmune disease. Robust epidemiology could
yield important information for all autoimmune diseases, not just
alopecia areata. CDC requires a meaningful investment in fiscal year
2015 so that it can expand its crucial public health activities beyond
winnable battles.
national institutes of health
NIH hosts a modest alopecia areata research portfolio, and the
Foundation works closely with NIH to advance critical activities. NIH
projects, in coordination with the Foundation's TDP, have the potential
to identify biomarkers and develop therapeutic targets. In fact,
alopecia areata research has a strong value proposition as scientific
advancements may have applications for other autoimmune and skin
diseases. Please provide NIH with meaningful funding increases to
facilitate growth in the alopecia areata research portfolio.
One exciting emerging opportunity is the new Accelerating Medicines
Partnership (AMP) that was recently announced by NIH. This effort is
outcomes-oriented and based on a public private-partnership model.
Industry, patient organizations, and researchers work together to
conduct research with the goals of improving treatments and diagnostic
tools. Rheumatoid arthritis is one of the diseases being examined in
the first round of study, which should generate opportunities for
alopecia areata due to the similarities between the conditions. Please
support AMP and encourage NIH to expand activities in this area,
particularly when there is research overlap between conditions
additional activities
FDA nominated alopecia areata as a potential condition for specific
review through the Patient-Focused Drug Development Initiative (PFDDI).
This is because many of the impacts of alopecia areata have to be
reported by patients and cannot be measured biologically. While we
appreciate that FDA falls under the guise of the Agriculture
Appropriations Subcommittee, we ask that you work with your colleagues
on the Appropriations Committee to support this important program.
Further, FDA should be encouraged to review all originally-nominated
conditions in a timely manner so the PFDDI can continue to move
forward.
Thank you for your time and your consideration of the community's
requests.
______
Prepared Statement of the National Association for Geriatric Education
The National Association for Geriatric Education (NAGE) is pleased
to submit this statement for the record recommending $41.997 million in
fiscal year 2015 to support geriatrics programs under the Health
Resources and Services Administration (HRSA), Title VII, Section 753 of
the Public Health Service Act. NAGE respectfully requests that the
Subcommittee return to its approved level for fiscal year 2010, which
was also included that year in the Administration's request, but was
not included in the final bill. Unfortunately, only $34 million was
funded in the final bill, and that has been cut to under $34 million in
subsequent years.
NAGE is a non-profit membership organization representing Geriatric
Education Centers (GECs) and other programs that provide education and
training to health professionals in the areas of geriatrics and
gerontology. Our mission is to help America's health workforce be
better prepared to render age-appropriate care to today's older
Americans and those of tomorrow.
NAGE recognizes the Subcommittee faces difficult decisions in a
constrained budget environment, a continued commitment to programs
supporting the growing need for geriatric education programs that help
the Nation's health professions better serve the older and disabled
population should remain a top priority. The Nation faces a shortage of
geriatric health professionals. Every day in America 10,000 more
persons reach the age of 65 years. There simply are not enough
geriatricians, gerontological nurse practitioners and the myriad other
health professions needed to provide interprofessional care to this
burgeoning older population.
Three geriatric health professions programs are financed under
Title VII, Section 753 of the Public Health Service Act and are
included in the Health Resources and Services Administration (HRSA).
Geriatric Education Centers (GECs) and their related programs, the
Geriatric Academic Career Awards and the Geriatric Faculty Fellowships,
provide much needed interdisciplinary geriatric and gerontology
training to a broad range of health professionals who serve our rapidly
growing aging population.
GECs train healthcare professional faculty, students, and
practitioners in the interprofessional diagnosis, management and
prevention of disease, disability, and other health problems of the
elderly. This program also provides interprofessional continuing
education for healthcare practitioners related to prominent issues in
the field of geriatrics, such as Alzheimer's disease, dementia, and
advances in palliative care, among others. The GEC program currently
funds 45 GECs in 34 States, including statewide and multi-state
programs. About half of GECs provide education for areas that are more
than 50 percent rural and one-fourth of GECs focuses on training in
areas that are 25-49 percent rural. In the 2012-2013 Academic Year, GEC
programs provided over 1,650 different continuing education courses to
over 94,000 trainees. GEC grantees exceeded the program's performance
goal by 58.5 percent.
Geriatrics Training for Physicians, Dentists, and Behavioral/Mental
Health Professionals (GTPD) support faculty fellowships that help
physicians, dentists, and behavioral and mental health professionals
who plan to teach geriatrics in their selected fields. The aim of the
program is increase the number of quality, culturally competent
geriatric faculty and to retain mid-career faculty in geriatrics. GTPD
provided funding for 64 fellows in the academia field of geriatric
medicine, dentistry, and psychiatry. The GTPD fellows received clinical
training in over 200 different healthcare locations across the Nation.
The majority were trained in Veteran's Affairs hospitals, private
hospitals and academic centers with nearly half of the sites located in
medically underserved communities. Notably, each fellow dedicated at
least 25 percent of their time for teaching health students about
geriatric-related topics. In Academic Year 2012-2013, it is estimated
that over 275 courses, workshops and other activities were delivered by
GTPD fellows.
Geriatrics Academic Career Awards (GACAs) provide a financial
incentive for junior faculty to pursue an academic career in
geriatrics. GACA currently supports 62 newly trained geriatric
physicians. Award recipients delivered over 1,110 different health
courses, workshops and other types of training activities to over
53,000 trainees across the health profession spectrum. The most common
health professions include medical school students, residents in
internal medicine and residents in geriatrics.
These successful programs improve the education, supply,
distribution, diversity, and quality of healthcare professionals who
care for our Nation's growing older adult population, including the
underserved and minorities. Thus, we need your continued support for
geriatric programs to adequately prepare the next generation of health
professionals for the rapidly changing and emerging needs of the
growing and aging population.
On behalf of NAGE, thank you for this opportunity to share our
requests for support for these important programs. We ask that you
thoughtfully consider our request for funding in fiscal year 2015.
[This statement was submitted by Thomas Caprio, MD, MPH, CMD, FACP,
University of Rochester, Division of Geriatrics & Aging; Co-Director,
Finger Lakes Geriatric Education Center, President, National
Association for Geriatric Education.]
______
Prepared Statement of the National Association for State Community
Services Programs
Mr. Chairman and Members of the committee, thank you for the
opportunity to submit this testimony on behalf of the National
Association for State Community Services Programs (NASCSP), a
membership association for the administrators of the federally-funded
Community Services Block Grant which serves millions of American
families in communities across the country. As the Executive Director
of NASCSP, I submit this testimony on behalf of the States in their
work to improve the lives of low-income families and strengthen local
economies. We are requesting that the Committee approve $710 million in
fiscal year 2015 to adequately fund the CSBG network. This level of
funding is the same as the fiscal year 2014 enacted funding for CSBG.
We strongly believe that CSBG is a wise strategic investment not only
in America's ongoing economic recovery, but in our Nation's long-term
economic stability as well. Maintaining funding is necessary not only
to continue CSBG's well-documented role in strengthening our economy,
but also for the ongoing reforms to the block grant which adapt it to
new realities and strengthen it for the next generation. We strongly
oppose the reduction in funding for CSBG as proposed by the
Administration, and I welcome this opportunity to explain exactly why.
First, however, I'd like to thank Congress for its past support of
CSBG. The services provided by this network are crucial to the millions
of Americans facing poverty and economic insecurity at a time when the
impact of the slow economy is affecting every Congressional District in
America. Right now, more than 46 million Americans are living below the
Federal poverty level (defined as $23,050 a year for a family of four).
CSBG directly addresses the need to help hard-working Americans who are
struggling in the present economy and to prevent people from slipping
further into poverty. The strength and productivity of our Nation
depends on the economic well-being of all of its citizens, and CSBG is
a proven strategy to support millions of low-income Americans on the
path to economic security. The CSBG network uses grassroots, innovative
strategies to alleviate poverty and provides a significant return on
taxpayers' investment. In fiscal year 2012, the CSBG network leveraged
$22.75 for every Federal dollar invested in CSBG.
By acting as a conduit between the Federal administration and local
community action agencies (CAA's), States build public-private
partnerships, support innovation, and advance best practices to ensure
the most effective use of taxpayers' money. Local agencies utilize CSBG
funds to leverage additional funds to eliminate poverty through a
variety of programs and services. While CAAs across the Nation address
similar issues, local needs determine unique approaches to addressing
them.
Poverty is a national problem, but can only be effectively
addressed at the grassroots level. The CSBG network strives to find
local solutions to these community issues by conducting community needs
assessments to keep in touch with the needs, challenges, and resources
in their community. The community needs assessments enable CAAs to
provide the most effective and efficient strategies and services. These
efforts fall into nine service categories outlined in the CSBG Act;
employment, education, income management, housing, emergency services,
nutrition, linkages, self-sufficiency, and health.
National data compiled by NASCSP shows that CSBG serves a broad
segment of low-income individuals and families. Data from fiscal year
2012 shows:
--There are 1,045 CAAs across the country, serving 99 percent of U.S.
counties;
--CSBG serves 1 out of every 5 people in America below the poverty
line;
--The majority of clients are female (58 percent), white (59
percent), renters (60 percent) and between the ages of 24--44
years old (24 percent)--the second largest group was children
ages 0-5 years old (14 percent);
--The majority of clients are receiving incomes from employment-
related sources (50 percent);
--Many of the families served (33 percent) were in ``severe
poverty,'' with incomes below 50 percent of the Federal Poverty
Guideline.
The successes of the CSBG network are well documented:
--CSBG served 16 million Americans including 76.9 million families in
fiscal year 2012.
--Over the past 5 years, the CSBG network helped over 630,000 people
obtain employment.
--Over the past 5 years, the CSBG network addressed 21.2 million
barriers to employment through helping people to either acquire
jobs, obtain employment supports, or to receive job training.
--Over the past 5 years, the CSBG network expanded 19.8 million
community opportunities or resources to stimulate community and
economic development.
--Over the past 5 years, the CSBG network facilitated 18.5 million
opportunities for infants, children, youth, parents and other
adults through developmental or enrichment programs.
States provide administrative oversight to ensure that eligible
entities are meeting State and Federal requirements as well as their
locally driven Community Action Plans. This includes monitoring
eligible entities, providing training and technical assistance,
investing in innovation, and maintaining effective performance
measurement and management systems. Adequate funding is needed to
maintain a high level of accountability and performance in the
following areas:
Support High Achievement and Innovation
Adequate funding, sufficient to meet national standards and
incentives must be provided to States, local agencies, and national
partners for high achievement and innovation. CSBG appropriations
should include sufficient resources for local agencies, States, and
national partners to engage in the work necessary to achieve the goals
of the CSBG Act and the Promise of Community Action, which includes
addressing the needs of vulnerable people and building strong
communities. It should create the opportunity to provide a consistent
resource to the people, families and communities that benefit from the
activities conducted under the Act. It should also provide funds to
extend the work to create and test innovative approaches as well as
include and engage an ever wider circle of partners.
Support Coordination of Services
NASCSP believes that a $710 million funding level for CSBG is
essential for continued innovation and stronger coordination. It will
also maintain the stature of the CSBG in both State and Federal
administrations. Further, adequate funds in the CSBG will create
additional opportunities and development for low-income programs and
will allow for further coordination with agencies outside our Network
that share a similar mission.
Mr. Chairman, I respectfully request the Committee to fund CSBG at
the level of $710 million in fiscal year 2015 to support America's
ongoing economic recovery and future economic stability. Maintaining
CSBG funding is an investment in both strengthening our economy and in
adapting our efforts to new realities for future generations of hard-
working Americans. Thank you.
[This statement was submitted by Jenae Conti Bjelland, Executive
Director, National Association for State Community Services Programs.]
______
Prepared Statement of the National Association of Chain Drug Stores
The National Association of Chain Drug Stores (NACDS) thanks the
Members of the Subcommittee on Labor, Health and Human Services,
Education and Related Agencies for the opportunity to submit the
following statement for the record regarding pharmacy-related
provisions contained within the fiscal year 2015 Department of Health
and Human Services (HHS) Budget. NACDS and the chain pharmacy industry
are committed to partnering with Congress, HHS, patients, and other
healthcare providers to improve the quality and affordability of
healthcare services.
NACDS represents traditional drug stores and supermarkets and mass
merchants with pharmacies. Chains operate more than 40,000 pharmacies,
and NACDS' 125 chain member companies include regional chains, with a
minimum of four stores, and national companies. Chains employ more than
3.8 million individuals, including 175,000 pharmacists. They fill over
2.7 billion prescriptions yearly, and help patients use medicines
correctly and safely, while offering innovative services that improve
patient health and healthcare affordability. NACDS members also include
more than 800 supplier partners and nearly 40 international members
representing 13 countries. For more information, visit www.NACDS.org.
As the face of neighborhood healthcare, community pharmacies and
pharmacists provide access to prescription medications and over-the-
counter products, as well as cost-effective health services such as
immunizations and disease screenings. Through personal interactions
with patients, face-to-face consultations and convenient access to
preventive care services, local pharmacists are helping to shape the
healthcare delivery system of tomorrow--in partnership with doctors,
nurses and others.
In recent years, retail community pharmacies have played an
increasingly important role in providing patient care, including
medication therapy management (MTM) and expanded immunization services.
Moreover, policymakers have begun to recognize the vital role that
local pharmacists can play in improving medication adherence. The role
of appropriate medication use in lowering healthcare costs has been
acknowledged by the Congressional Budget Office (CBO). The CBO revised
its methodology for scoring proposals related to Medicare Part D and
found that for each 1 percent increase in the number of prescriptions
filled by beneficiaries there is a corresponding decrease in overall
Medicare spending. When projected to the entire population, this
translates into a savings of $1.7 billion in overall healthcare costs,
or a savings of $5.76 for every person in the U.S. for every 1 percent
increase in the number of prescriptions filled.
Congress has recognized the importance of pharmacist-provided
services such as MTM by including it as a required offering in the
Medicare Part D program. The experiences of Part D beneficiaries, as
well as public and private studies, have confirmed the effectiveness of
pharmacist-provided MTM. A 2013 Centers for Medicare and Medicaid
Services (CMS) report found that Part D MTM programs consistently and
substantially improved medication adherence and quality of prescribing
for evidence-based medications for beneficiaries with congestive heart
failure, COPD, and diabetes. The study also found significant
reductions in hospital costs, particularly when a comprehensive
medication review (CMR) was utilized. This included savings of nearly
$400 to $525 in overall hospitalization costs for beneficiaries with
diabetes and congestive heart failure. The report also found that MTM
can lead to reduced costs in the Part D program as well; showing that
the best performing plan reduced Part D costs for diabetes patients by
an average of $45 per patient.
How and where MTM services are provided also impact its
effectiveness. A study published in the January 2012 edition of Health
Affairs identified the key role of retail pharmacies in providing MTM
services. The study found that a pharmacy-based intervention program
increased adherence for patients with diabetes and that the benefits
were greater for those who received counseling in a retail, face-to-
face setting as opposed to a phone call from a mail-order pharmacist.
The study suggested that interventions such as in-person, face-to-face
interaction between the retail pharmacist and the patient contributed
to improved adherence behavior with a return on investment of 3 to 1.
Since pharmacists have the proven ability to provide services that
lead to better clinical outcomes and lower healthcare costs, we urge
the implementation of budget proposals that allow all healthcare
providers, including retail pharmacists, to practice to their maximum
capabilities, working in partnership to provide accessible, high
quality care to patients.
NACDS appreciates HHS's proposed goals to reduce healthcare costs
and produce a more efficient healthcare system; however, we have
concerns with some proposals contained in the fiscal year 2015 HHS
Budget. HHS has proposed excluding brand and authorized generic drugs
from the calculation of average manufacture price (AMP), thereby
calculating Medicaid Federal Upper Limits (FULs) based only on generic
drug prices. While the goal of this provision may be to decrease
Medicaid costs, we believe it may in fact reduce access to prescription
drugs and pharmacy services for Medicaid patients, resulting in
increased overall healthcare expenditures.
Given that AMP has never been used as a basis for pharmacy
reimbursement, and that AMP-based FULs remain in draft form, we believe
the fiscal year 2015 budget provisions changing the calculation of FULs
are premature. In fact, based on NACDS' most recent analysis,
approximately 35 percent of the draft FULs are below National Average
Drug Acquisition Cost (NADAC). This analysis confirms that additional
efforts by CMS are necessary to ensure that pharmacies are not
reimbursed below their costs using the reimbursement formula created by
the Affordable Care Act. We urge CMS to utilize the rulemaking process
to implement the Medicaid pharmacy provisions in a manner consistent
with Congressional intent, rather than pursuing policies that would
further cut pharmacy reimbursement.
The fiscal year 2015 HHS Budget includes a proposal to limit
Medicaid reimbursement of durable medical equipment (DME) to the rates
paid by Medicare. Implementing a blanket proposal to reduce payment for
Medicaid DME has the potential to disrupt access to DME and produce
poorer health outcomes. This is particularly true in the case of
diabetes testing supplies (DTS). Last year, CMS established a new
Medicare single payment of $10.41 for DTS. This amount drastically
decreased Medicare reimbursement by an average of 72 percent for retail
pharmacies. The current reimbursement amount barely covers a pharmacy's
costs-of-goods plus dispensing and counseling for these products and
services. Reducing Medicaid reimbursement for DTS to match the Medicare
rate could similarly produce hardships for Medicaid beneficiaries in
terms of reducing access to needed supplies and threatening the health
of an already fragile population. NACDS urges CMS to refrain from
making any changes to Medicaid reimbursement for DTS.
The fiscal year 2015 budget also includes several provisions to
increase the utilization of generic drugs. NACDS applauds the inclusion
of these important provisions, which would encourage the use of generic
medications by Medicare Low Income Subsidy (LIS) beneficiaries, and
promote generic competition for biologics. Increasing generic
utilization is one of the most effective ways of controlling
prescription drug costs, and the generic dispensing rate of retail
pharmacies--80 percent--is higher than any other practice setting.
Finally, the fiscal year 2015 HHS Budget includes a number of
proposals to cut waste, fraud and abuse in the Medicare and Medicaid
programs, including the ability to suspend coverage and payment for
questionable Part D prescriptions. NACDS applauds HHS for working to
ensure that such activity does not exist in these Federal programs.
However, NACDS urges HHS to move forward in a cautious manner which
does not disrupt beneficiary access or jeopardize beneficiary health.
This can be done by ensuring that overly-burdensome requirements are
not placed on providers to the point that it interferes with the
ability to treat and care for patients.
NACDS thanks the Subcommittee for consideration of our comments. We
look forward to working with policymakers and stakeholders on these
important issues.
______
Prepared Statement of the National Association of Community Health
Centers
Introduction
Chairman Harkin, Ranking Member Moran, and Distinguished Members of
the Subcommittee: on behalf of health centers across the Nation, we
wish to thank you for the opportunity to submit testimony for the
committee to review as you craft the fiscal year 2015 Labor-Health and
Human Services-Education and Related Agencies Appropriations bill.
Health Centers- General Background
Health Centers are community-owned and operated non-profit entities
providing primary medical, dental, and behavioral healthcare as well as
pharmacy and a variety of enabling and support services. Today, there
are over 1,200 health centers operating at more than 9,000 urban and
rural communities nationwide. We are the ``healthcare home'' for more
than 22 million patients in all 50 States and nearly every
Congressional district.
By statute and mission, health centers are located in medically
underserved areas or serve a medically underserved population. Health
centers are directed by patient-majority boards, a model which helps to
ensure they are responsive to the needs of each individual community
they serve. Health centers offer comprehensive care to all residents of
the community who seek their care, regardless of ability to pay or
insurance status and offer services on a sliding fee scale. Our unique
model of care has enabled us to save the entire health system
approximately $24 billion annually. Health Centers reduce preventable
hospitalizations and Emergency Department use, as well as the need for
more expensive specialty care. The services provided at health centers
save $1,263 per patient per year compared to expenditures for non-
health center users.
In addition to reducing costs, health centers also serve as small
businesses and economic drivers in their communities. In 2012, health
centers employed 153,000 individuals and in 2009 generated $20 billion
in total economic benefits in poor urban and rural communities.
Fiscal year 2014 Funding Background
In fiscal year 2014, health centers received a total of $3.7
billion in total Federal funding. This includes $1.49 billion in
discretionary funding provided by the Health Resources and Services
Administration (HRSA) and $2.2 billion in mandatory funding for health
centers through the Health Center Fund. We want to thank the members of
this Subcommittee for their support of health centers within the
Consolidated Appropriations Act of 2014 to ensure health center funding
continues to reach communities in need.
Access to a Health Center Reduces Barriers to Primary Care
NACHC's recently released a report entitled: Access is the Answer
finds 62 million Americans lack regular access to primary care and the
vast majority of these medically disenfranchised Americans actually
have insurance coverage. Many individuals still face barriers such as
availability, affordability, and accessibility to primary and
preventive care. Even among people who have an insurance card, access
may be out of reach because of who they are and where they live. As
health reform changes the healthcare landscape, we know that demand for
health centers will continue to climb among the uninsured, underinsured
and underserved due to the lack of other healthcare providers willing
to see our patients.
True ``access'' means having a regular, reliable source of quality
preventive and primary healthcare and simply having an insurance card
does not guarantee ready access to primary care. With our unique model
of care, Health Centers can help address these primary care demands in
a cost effective manner. However, Health Centers cannot continue to
deliver results without a sound financial base.
Fiscal year 2015 Funding Request and Health Center Funding Cliff
In fiscal year 2015, Health Centers are respectfully requesting
level discretionary funding of $1.49 billion for the Health Center
program. Together with the $3.6 billion in funding available in fiscal
year 2015 through the mandatory Health Center Fund, health centers are
requesting a total of $5.1 billion in total program funding. This
funding for the Health Center program, which requires no new
appropriation from this Subcommittee, should be fully utilized during
fiscal year 2015 to increase access to primary care in medically
underserved communities. With access to all available funding for the
program in fiscal year 2015, Health Centers could build the capacity to
serve up to 11 million new patients, both in new communities and
through expanded services and capacity at existing health centers. In
addition, existing Health Centers could ensure they are keeping up with
current patient demand.
The President's proposed fiscal year 2015 Health Resources and
Services Administration (HRSA) budget provides $1 billion in
discretionary funding for the Health Centers program. Together with the
$3.6 billion in fiscal year 2015 mandatory funding available for health
centers, under the President's proposal, health centers would receive a
net increase of $960 million in total programmatic funding for fiscal
year 2015 equaling total funding of $4.6 billion. Within this proposal,
the President will allocate $860 million for one-time quality
improvement and capital development awards and $100 million to fund new
health center sites.
We strongly oppose the President's proposed $500 million
discretionary funding reduction for health centers as it further
reduces the discretionary allocation for the program beyond the levels
in place prior to the inception of the Health Center Fund. Health
centers simply cannot survive further decreases to their base
discretionary funding which undermines the long-term sustainability of
the program, and may well threaten access for existing patients.
We do appreciate the President's acknowledgement and recognition of
the looming funding crisis for health centers upon the expiration of
the Health Center Fund after fiscal year 2015. Under current law the
Health Center Fund will end after fiscal year 2015, resulting in as
much as a 70 percent reduction in health center grant funding in fiscal
year 2016. Averting the health center cliff is critical to ensuring
that health centers remain financially viable and able to serve the
diverse needs of their communities. However, the President only
proposes a temporary (3 year) solution reducing program funding down to
fiscal year 2014 levels after a one-time increase in fiscal year 2015.
Given the number of communities and individuals in need of access to
healthcare, longer-term solutions must encompass both stability and
expansion of access to care.
Conclusion
We understand this Subcommittee must make difficult budgetary
decisions as you work within the funding limits set for the
subcommittee's bill. As the fiscal year 2015 appropriations process
moves forward, we urge you to keep in mind that without their local
health center, many individuals located in medically underserved
communities will seek care in emergency departments and hospitals,
often waiting until they are sicker get treatment. This will mean
poorer health for these patients and much higher costs to the system.
Health centers have continually proven to be a worthwhile investment by
delivering high quality, affordable healthcare while generating savings
to the entire health system in these communities. We are extremely
grateful for your past support and ask for the Subcommittee's continued
support for the Health Center program. We look forward to working with
you and thank you for your consideration.
[This statement was submitted by Daniel R. Hawkins, Jr., Senior
Vice President, Public Policy and Research.]
______
Prepared Statement of the National Association of County and City
Health Officials
The National Association of County and City Health Officials
(NACCHO) is the voice of the 2,800 local health departments across the
country that work every day to ensure the safety of the water we drink,
the food we eat, and the air we breathe. On behalf of local health
departments, NACCHO submits the following requests:
Prevention and Public Health Fund
In fiscal year 2015, NACCHO requests $1 billion for the Prevention
and Public Health Fund (PPHF), a dedicated Federal investment in
programs that prevent disease at the community level. NACCHO wishes to
thank Congress for allocating the PPHF in fiscal year 2014 and setting
specific funding levels to support the prevention of disease and
promotion of health in communities across the Nation.
CDC Public Health Emergency Preparedness
NACCHO urges the Subcommittee to provide $675 million for the
Public Health Emergency Preparedness (PHEP) grant program in fiscal
year 2015. PHEP protects communities by strengthening local and State
public health department capacity to effectively respond to public
health emergencies including terrorist threats, infectious disease
outbreaks, natural disasters, and biological, chemical, nuclear, and
radiological emergencies. These grants have been cut more than 30
percent since fiscal year 2007 with more than 55 percent of local
health departments relying solely on Federal funds for emergency
preparedness activities. NACCHO urges inclusion of language asking CDC
to provide information on how much of the State PHEP grants are being
allocated to local health departments and on what basis or formula each
State is determining such allocations, including the method through
which States reach statutorily-required concurrence with local health
departments.
Assistant Secretary for Preparedness and Response
NACCHO urges the Subcommittee to fund the Hospital Preparedness
Program (HPP) at $300 million in fiscal year 2015 and restore some of
the $104 million (35 percent) cut from the program in fiscal year
2014.. HPP supports health department preparedness coordinators to
organize coalitions of public health and healthcare providers to plan
and prepare for public health emergencies, including medical surge
following terrorist attacks, mass casualty incidents, an influenza
pandemic or other infectious disease outbreak. NACCHO is concerned that
the 35 percent cut to HPP in fiscal year 2014 will erode medical system
preparedness, making communities across the country more vulnerable.
NACCHO urges Congress to request information from Assistant Secretary
for Preparedness and Response (ASPR) on how State HPP funding is
distributed at the local level, including how much is being allocated
to local health departments and on what basis or formula each State
making such allocations. This information should be publicly available.
CDC Section 317 Immunization Program
NACCHO urges the Subcommittee to provide $650 million for the
Section 317 Immunization Program in fiscal year 2015. The Section 317
Immunization Program funds 50 States, six large cities and eight
territories for vaccine purchase for at-need populations and
immunization program operations, including support for implementing
immunization billing systems at public health clinics to sustain high
levels of vaccine coverage. NACCHO supports directing $8 million of the
funding, as proposed in the President's Budget, to continue projects to
facilitate billing by health departments of public and private
insurance for covered immunization services.
CDC Chronic Disease Prevention
Partnerships to Improve Community Health (Community Prevention
Grants).--NACCHO urges the Subcommittee to provide $100 million to
support continuation of the Partnerships to Improve Community Health
program in fiscal year 2015, which supports implementation of evidence-
based strategies to address heart attacks, strokes, cancer, diabetes,
and other chronic diseases which contribute to the soaring cost of
healthcare. Local health departments lead efforts to reduce tobacco
use, increase physical activity and expand access to nutrition in order
to reduce costly chronic diseases like heart disease and diabetes.
NACCHO urges Congress to encourage CDC to conduct a comprehensive
national evaluation of the program including recommendations for
national qualitative and quantitative standards for quality preventive
services and a report of how much of the funding was granted to the
local level and to which eligible entities.
Heart Disease and Stroke.--NACCHO urges the Subcommittee to
continue to support Heart Disease and Stroke Prevention at $130 million
in fiscal year 2015. In fiscal year 2014, Congress provided a $76
million increase for heart disease and stroke prevention and urged CDC
to ensure that some portion of the increase in funding is sub-granted
to the local level. The risk factors of obesity and smoking must be
addressed at the community level to combat disease. Local health
departments who are experts on community needs and prevention
interventions in the area of heart disease and stroke.
Diabetes Prevention and Control.--NACCHO urges the Subcommittee to
continue to support Diabetes Prevention at $150 million in fiscal year
2015. In fiscal year 2014, Congress provided a $76 million increase for
diabetes prevention and urged CDC to ensure that some portion of the
increase in funding is sub-granted to the local level. Because
evidence-based disease self-management programs are effective at
improving health, greater emphasis must be placed on enhancing the
reach of these community level interventions.
CDC Preventive Health and Health Services Block Grant
In fiscal year 2015, NACCHO urges the Subcommittee to continue to
support the Preventive Health and Health Services (PHHS) Block Grant at
$160 million. This unique funding gives States the flexibility to
address State problems and provide similar support to local
communities, while demonstrating the local, State, and national impact
of this investment. NACCHO urges Congress to encourage CDC to enhance
reporting and accountability for the PHHS Block Grant including
providing capacity building to States for core public health capacities
that may not be supported through other CDC categorical funding
streams. In order to make sure that funding supports the needs of local
communities, local health departments should be full partners in
developing State plans. CDC should also require States to report the
funding allocation used to subgrant funds to local health departments
and to encourage they include locals in their statewide planning
efforts.
CDC Food Safety
NACCHO urges the Subcommittee to support CDC's Food Safety Program
at $54 million in fiscal year 2015. Local and State health departments
are an essential part of the process that ensures that food is safe to
eat at home, at community events, in restaurants, and in schools.
As the Subcommittee drafts the fiscal year 2015 Labor-HHS-Education
Appropriations bill, NACCHO urges consideration of these
recommendations for programs that protect the public's health and
safety.
______
Prepared Statement of the National Association of State Directors of
Career and Technical Education Consortium
Dear Chairman Mikulski, Ranking Member Shelby, Chairman Harkin and
Ranking Member Moran: On behalf of the National Association of State
Directors of Career and Technical Education Consortium (NASDCTEc), I am
writing to urge the committee to support Career Technical Education
(CTE) through a strong Federal investment in the Carl D. Perkins Career
and Technical Education Act (Perkins). The passage of the Consolidated
Appropriations Act of 2014 has helped to alleviate most of the harmful
sequester cuts which have negatively impacted important Federal
investments in CTE programs through this legislation. However, our
organization recognizes that there are still difficult decisions to be
made regarding individual program funding levels in fiscal year 2015.
To that end, NASDCTEc is requesting that the committee restore funding
for the Perkins Basic State Grant to at least $1.264 billion,
equivalent to the pre-sequestration level of 2010, and make investing
in Perkins a top priority in the fiscal year 2015 Labor, Health and
Human Services, and Education appropriations bill.
Perkins is the principal source of Federal support for CTE programs
at secondary and postsecondary institutions across the county. This
Federal investment is crucial to ensuring that students have the
academic, technical and employability skills that are needed for
expanding fields like engineering, information technology, advanced
manufacturing and healthcare. Perkins-funded CTE programs are working
with business and industry partners to help fill positions that are
available today, while preparing a qualified workforce for the careers
of tomorrow. In a rapidly changing job market, CTE provides students
with transferable skills that ensure they are college-and career-ready,
while offering retraining opportunities to many adult or dislocated
workers.
CTE produces a strong return on the Federal investment and has an
unmistakably positive societal and economic impact. Students enrolled
in CTE programs are more engaged, perform better academically and
graduate at higher rates. CTE supports the development of an educated
and highly skilled workforce that provides a direct benefit to
employers, while strengthening the economy through increased
productivity and innovation.
However, funding for CTE has not been immune to significant budget
cuts over the past several years. The Perkins Act basic State grant
program still remains approximately $5 million below pre-sequestration
levels. In addition to sequestration, funding for Perkins was reduced
by over $140 million between fiscal year 2010 and fiscal year 2012,
dramatically reducing the capacity of CTE programs to offer
academically rigorous instruction and career training that is aligned
to the needs of business and industry. Dozens of States are currently
receiving funding allocations close to the levels they received in
1998. When taking into account inflation over this period, the relative
investment in CTE through the Perkins Act has declined considerably
more. This erosion has hurt high schools, CTE centers, community and
technical colleges, employers and millions of CTE students nationwide.
This pathway of disinvestment in our Nation's CTE system is
unsustainable-- we cannot cut our way to a 21st century workforce!
Instead, Perkins funding must be restored to meet the needs of CTE
programs around the country and ensure students are fully prepared for
their future academic and career goals.
Thank you for your continued leadership in this difficult fiscal
environment and for your thoughtful consideration during the
appropriations process. NASDCTEc looks forward to working with the
committee in a bipartisan fashion to restore funding for CTE and
support the millions of CTE students across the Nation.
[This statement was submitted by Kimberly Green, Executive
Director, National Association of State Directors of Career and
Technical Education Consortium.]
______
Prepared Statement of the National Association of State Head Injury
Administrators
Dear Chairman Tom Harkin and Ranking Member Jerry Moran: On behalf
of the National Association of State Head Injury Administrators
(NASHIA), thank you for the opportunity to submit testimony regarding
the fiscal year 2015 appropriations for programs authorized by the
Traumatic Brain Injury (TBI) Act within the Department of Health and
Human Services (HHS). The TBI Act programs are the only programs
providing Federal assistance to help States with developing an array of
rehabilitation, home and community-based services and other short-term
and long-term supports specific to the cognitive and behavioral needs
of individuals with TBI and their families. These programs are designed
to restore and improve functioning and assist individuals to return to
school, engage in employment and to live as independently as possible.
To assist States in improving and expanding service delivery, NASHIA
recommends the following:
Centers for Disease Control and Prevention (CDC), National Injury
Center
The CDC National Injury Center supports State TBI registries,
surveillance, data collection and analysis; State and local prevention
interventions to address falls related, motor vehicle related, and
sports-related injuries, including concussions (mild TBI); as well as
educates primary clinicians and other professionals to be able to
identify, diagnose and manage TBIs appropriately and effectively.
NASHIA recommends an increase in funding for the CDC TBI Program in the
amount of $10 million to address the expanding population of
TBI.
CDC's National Injury Center is the primary Federal agency
responsible for translating science into effective programs and
policies to prevent and minimize the consequences of TBI when they
occur. Through its funded programs and activities, the Injury Center
works with national organizations, Federal agencies, State health
agencies, and other key groups to develop, implement, and promote
effective injury and violence prevention and control practices.
Health Resources and Services Administration (HRSA), Federal TBI
Program
NASHIA recommends $12 million total for the HRSA TBI Federal
Program, which is split by HRSA between two programs: HRSA Federal TBI
State Grant Program and the HRSA Federal TBI Protection & Advocacy
(P&A) Systems Grant Program.
HRSA Federal TBI State Grant Program
Since 1997, HRSA has awarded grants to 48 States, District of
Columbia and one Territory, although not concurrently, to develop and
improve services and systems to address the short-term and long-term
needs. These grants have been time limited and are relatively small.
Five years ago, HRSA increased the amount of the award from
approximately $100,000 to $250,000 to make it more feasible for States
to carry out their grant goals and the legislative intent. While this
increased amount is more attractive to States, this change reduced the
number of grantees to 21--less than half of the States and Territories
receive funding. As a result, States that do not have Federal grant
funding are finding it increasingly difficult to sustain their previous
efforts, let alone expand and improve service delivery, due to other
budget constraints within their States. Therefore, NASHIA recommends:
$8 million in total for the HRSA Federal TBI State Grant Program to
increase the number of State grant awards.
Over the course of the grant program, States have developed State
plans and implemented initiatives for improving service delivery;
information & referral systems; service coordination systems; outreach
and screening among unidentified populations such as children, victims
of domestic violence, and veterans; and training programs for direct
care workers and other staff. States have conducted public awareness
and educational activities that have helped States to leverage and
coordinate funding in order to maximize resources within States to the
benefit of individuals with TBI.
While NASHIA is well aware that Federal funds are becoming
increasingly difficult to obtain, NASHIA is recommending increased
funding for the Federal TBI Act programs because:
--The number of Americans who sustain a TBI is increasing, especially
among older adults and young children, and among our men and
women in uniform as a result of the wars in Iraq and
Afghanistan.
--All States have enacted legislation to develop return to play
guidelines with regard to sports-related concussions among our
youth. Two States have recently expanded their laws to include
``return to learn'' guidelines to help with the identification
of TBI and appropriate accommodations and related educational
assistance that may be needed after a mild TBI (concussion) in
order to be successful academically. Through these efforts,
children and youth are now being identified and screened for
potential assistance.
--State budgets have not been able to keep up with the demand for
services.
HRSA Federal TBI Protection & Advocacy (P&A) Systems Grant Program
HRSA also administers the Federal TBI P&A Systems Grant Program
which is a formula-based program that allows 57 States, Territories,
and the Native American Protection and Advocacy Project to assess their
State P&A Systems' responsiveness to TBI issues and provide advocacy
support to individuals with TBI and their families. Together, P&As
comprise the Nation's largest provider of legally based advocacy
services for people with disabilities. To further the work of the P&As,
NASHIA recommends:
$4 million in total be appropriated to increase the amount of grant
awards administered by HRSA Federal TBI P&A Systems Grant
Program.
The TBI Act, which was last reauthorized in 2008, is due for
reauthorization. TBI stakeholders are working with key Congressional
leaders to extend authorization of appropriations for these critical
programs. In addition:
NASHIA recommends transferring the HRSA TBI State Grant and P&A
programs to the Administration for Community Living to maximize
resources to support the array of services and supports needed
following a brain injury.
Transferring the TBI State Grant and P&A Grant programs within ACL
would:
--Integrate TBI into the HHS long-term services initiatives, which
also rely on Aging and Disability Resource Centers (ADRCs) as
the entry point into these systems;
--Promote collaboration with the Administration on Aging (AoA) on
falls related TBIs among older adults;
--Include TBI in the veterans initiatives between HHS and Department
of Veterans Affairs to support Home and Community-Based
Services (HCBS) for veterans and returning servicemembers
coordinated by the ACL's Office of Disability and Aging
Policy's Office of Integrated Programs;
--Coordinate and enhance services for individuals with TBI who could
benefit from the ACL's Administration on Intellectual/
Developmental Disabilities (AIDD) initiatives to improve
education, transition services, employment outcomes and self-
advocacy for children and youth; and
--Include TBI in the Office of Disability and Aging Policy's Office
of Integrated Policy initiatives (i.e. Lifespan Respite Care
Program, Participant Direction Program, Evidenced-Based Care
Transitions, and Transportation Research and Demonstration
Program).
In keeping with the Olmstead decision, States are taking advantage
of Federal initiatives and opportunities to expand community long-term
services options. Unfortunately, most States focus on the traditional
populations of I/DD, physical disabilities, aging and mental health and
are omitting TBI in their long-term care initiatives. This leaves
individuals with TBI with little options, other than nursing facilities
or other segregated living programs, for assistance with activities of
daily living and residential or housing needs. We believe that aligning
the Federal TBI State Grant Program with these other programs will help
address these concerns.
About the National Association of State Head Injury Administrators
(NASHIA)
NASHIA is a non-profit organization representing and assisting
State governmental officials who administer an array of short-term and
long-term rehabilitation and community services and supports for
individuals with TBI and their families. Since 1990, NASHIA has held an
annual State-of-the-States conference, and has served as a resource to
State TBI program managers and others seeking public programs and
services. Membership also includes associate members who are
professionals, provider agencies, State affiliates of the Brain Injury
Association of America (BIAA) or U.S. Brain Injury Alliance, family
members and individuals with TBI.
Over the past 30 years, States have initiated efforts to develop
capacity for offering information and referral services, service
coordination, rehabilitation, in-home support, personal care,
counseling, transportation, housing, vocational and other support
services for persons with TBI and their families. These services vary
in size and scope across the country and even within a State. Twenty-
four States have enacted legislation to assess fines or surcharges to
traffic related offenses or other criminal offenses and/or assessed
additional fees to motor vehicle registration or drivers license to
generate funding for TBI programs and services, generally referred to
as trust fund programs. About the same number of States have
implemented TBI Home and Community-Based Medicaid Waiver Programs with
twelve States having the advantage of administering both a trust fund
and waiver program. These programs are administered by State public
health, Vocational Rehabilitation, mental health, Medicaid,
intellectual disabilities, education or social services agencies within
the States.
Thank you.
______
Prepared Statement of the National Association of State Long-Term Care
Ombudsman Programs
I am pleased to present this testimony on behalf of residents and
tenants residing in Iowa's long-term care facilities in collaboration
with the National Association of State Long-Term Care Ombudsman
Programs (NASOP). This statement and the following funding
recommendations for fiscal year 2015 for the Long-Term Care Ombudsman
Programs administered through the Administration for Community Living
(ACL) is submitted for the record.
--$5 million authorized under the Elder Justice Act for Long-Term
Care Ombudsman Program (LTCOP) services and training to fight
elder abuse, neglect, and exploitation;
--$16.83 million authorized under Title VII of the Older Americans
Act for LTCOPs to restore funding back to the fiscal year 2011
level;
--$20 million for LTCOP services in assisted living facilities; and
--$1 million authorized under Title II of the Older Americans Act for
the National Long-Term Care Ombudsman Resource Center (NORC).
NASOP, formed in 1985 as a non-profit organization, is composed of
state long-term care ombudsmen representing their State programs
created by the Older Americans Act (OAA). The primary function of the
LTCOP in the Federal OAA is to identify, investigate, and resolve
complaints that relate to action, inaction or decisions that may
adversely affect the health, safety, welfare, and rights of residents
of long-term care facilities. Ombudsman representatives work with the
consent and at the direction of residents in the resolution of their
problems. They visit residents living in nursing homes and residential
care homes. Ombudsman representatives ask them about problems or
concerns they have and if they need or want our help to resolve these
issues. Ombudsman representatives act as their advocates. We strongly
believe that our work not only improves the quality of life for
millions of long-term care facility residents, but also saves Medicare
and Medicaid resources by avoiding unnecessary costs associated with
poor quality care.
Nationally, n Federal fiscal year 2012, over 11,000 volunteers,
including 8,712 individuals certified to investigate complaints, and
1,180 staff served in 573 local LTCOPs. Ombudsmen investigated and
worked to resolve 193,650 complaints made by 126,398 individuals.
Ombudsmen were able to resolve or partially resolve 73 percent, or
almost three out of every four complaints investigated. In addition,
ombudsmen provided information on rights, care and related services
405,589 times.
Iowa's LTCOP is responsible for advocating for 53,287 residents and
tenants residing within 844 long-term care facilities. The Iowa Office
of State Long-Term Care Ombudsman consists of the State Long-Term Care
Ombudsman; 8 Local Long-Term Care Ombudsman; 2 Volunteer Coordinators;
numerous volunteers, and an Administrative Assistant. Currently, the
Federal funding for our program only fully funds two (2) of the twelve
(12) paid positions.
In Federal fiscal year 2013, Iowa's LTCOP received 1,174 complaints
by or on behalf of residents and tenants; directly served 3,226
residents and tenants; provided 4,445 hours of advocacy services beyond
complaint handling; and provided 5,360 consultations, education
sessions, visits, and other activities. Our office advocates for 53,
287 residents/tenants in 844 facilities and we do this with just a few
staff. We are grateful for the staffing that we do have, but feel that
our efforts are just a drop in the bucket. According to two national
studies from the Institute of Medicine and the Bader Report, the
national recommendation for States to follow is 1 long-term care
ombudsman for 2,000 beds or people. With the current number of long-
term care ombudsman staff in Iowa, our ombudsmen are serving 6,661 beds
or people. Iowa would need a total of 27 local long-term care ombudsmen
to fully meet this Federal recommendation. This would ensure that all
individuals residing in long-term care would have immediate access to
an advocate who can represent their interests.
We understand that this Subcommittee faces a strained financial
situation, but a continued commitment to Ombudsman programs advocating
for the healthcare needs and safety of millions of older adults living
in nursing homes and assisted living facilities across the Nation
should remain a high priority. Since 1978, the LTCOP has been a core
program of the OAA. It is the only program in the OAA that specifically
serves residents of nursing homes and assisted living facilities. We
all appreciate and value the importance of living in one's own home.
The OAA provides critically needed home and community based services
that often delay institutionalization. However, some elders can no
longer live safely in their own homes and must move at some point in
their lives to either an assisted living facility or a nursing home.
These residents are usually frail and extremely vulnerable and rely on
the advocacy services of the LTCOP.
Demand for our services and advocacy is growing. The number of
complex and very troubling cases that long-term care ombudsmen
investigate has been steadily increasing. In addition, there continues
to be a disturbing increase in the frequency and severity of citations
for egregious regulatory violations by long-term care providers. These
violations put facility residents in immediate jeopardy of harm. This
trend suggests a frightening decline in the quality of long-term care
services. Ombudsmen are needed now more than ever in nursing homes,
board and care facilities, and in assisted living communities. As well,
the demand placed on the program by the need to assist residents who
are relocating from long-term care facilities that are downsizing or
closing their doors continues to complicate ombudsman programs' daily
operations.
Administrators in many long-term care facilities have recognized
the value and benefit of having ombudsmen assist with staff training
and consultation and this form of outreach has also placed an
increasing strain on available advocacy resources. In order to improve
advocacy and services available to residents of long-term care
facilities, NASOP recommends, and the Iowa Office of the State Long-
Term Care Ombudsman supports, several augmentations to appropriations
that support the work of LTCOP.
NASOP requests $5 million to support the work of the LTCOP under
the Elder Justice Act. This appropriation would allow States to hire
additional staff and leverage that staff to recruit additional
volunteers to help support the investigation of complaints of abuse,
neglect, and exploitation of residents of nursing home and assisted
living facilities.
NASOP request $16.83 million authorized under Title VII of the
Older Americans Act for LTCOPs to restore funding back to the fiscal
year 2011 level. Programs in every district and State are suffering
from recent cuts. These funds would help in a partial way to restore
our reduced ability to visit residents in nursing homes.
NASOP requests $20 million to support 333 additional Ombudsman
salaried staff at an estimated $60,000 average annual salary/fringe
benefits and necessary staff training. The requests adds new ombudsman
positions specifically dedicated to providing Ombudsman services to
residents of assisted living facilities and other community-based long-
term care delivery systems, which currently suffer from a significant
lack of personnel resources around the country.
Finally, NASOP wants to acknowledge the importance and value of the
National Long-Term Care Ombudsman Resource Center (NORC). The NORC
provides valuable and reliable technical assistance, training, and
support to State and local LTCOPs.
NASOP requests an appropriation of $1 million to support the work
of the NORC in providing training and technical assistance to State and
local LTCOPs. Congress funds the NORC at $550,000 per year; the very
same level of funding it has received since 1993. This request adds
$450,000 to the line item for the NORC, which is such a critical
component of the ombudsman program. The NORC plays an integral role in
assuring the overall effectiveness of LTCOPs across the country through
its training, educational materials, data analysis, and best practices
efforts.
Overall, Ombudsmen offer valuable consumer protections to residents
and provide a voice for those unable to speak for themselves. Every day
in America, 10,000 more persons reach the age of 65 years. With a
rapidly growing older population, LTCOPs can continue to enhance the
quality of life, improve the level of care, protect the individual's
rights and promote the dignity of Americans across the Nation.
On behalf of residents, tenants and State Long-Term Care Ombudsmen
across this Nation, thank you for this opportunity to share these
requests for support of this important program that protects the
health, safety, welfare, and rights of vulnerable older adults and
persons with disabilities. We ask that you thoughtfully consider our
detailed request for funding in fiscal year 2015.
[This statement was submitted by Deanna Clingan-Fischer, JD, Iowa
State Long-Term Care Ombudsman.]
______
Prepared Statement of the National Association of States United for
Aging and Disabilities
Chairman Harkin, Ranking Member Moran: Thank you to for the
opportunity to submit this testimony. As you work to develop fiscal
year 2015 funding priorities, the National Association of States United
for Aging and Disabilities (NASUAD) urges you to consider the
Administration for Community Living's (ACL) fiscal year 2015 request
for $25 million to address the all-too prevalent problem of elder
abuse. This investment would support initial implementation of the
Elder Justice Act's (EJA) Adult Protective Services (APS), research,
and evaluation activities.
NASUAD represents the 56 officially designated State and
territorial agencies on aging and disabilities. Each of our members
oversees the implementation of the Older Americans Act (OAA), and many
also serve as the operating agency in their State for Medicaid waivers
that serve older adults and individuals with disabilities. Together
with our members, we work to design, improve, and sustain State systems
delivering home and community based services and supports for people
who are older or have a disability, and their caregivers.
According to ACL, an estimated 2.1 million older Americans are
victims of elder abuse, neglect, or exploitation each year. As the
Nation's older population increases, so too does the incidence of elder
abuse. While there is no single set of national elder abuse prevalence
data, the number of reported cases is on the rise. A 2004 national
survey of State APS programs showed a 16 percent increase in the number
of elder abuse cases from an identical study conducted in 2000.
Additionally, an overwhelming number of cases of abuse, neglect, and
exploitation go undetected and untreated each year. Experts estimate
that for every case of elder abuse or neglect reported, as many as five
cases go unreported.
Despite the clear and growing need, there is no dedicated Federal
funding for, or corresponding Federal oversight of, elder abuse
prevention services. Absent a national framework, States have been left
to address this issue independently from one another, and must rely on
multiple funding streams to support their work, ultimately resulting in
a fragmented system. Though each State has developed an APS program
that responds to reports of elder abuse, neglect, and exploitation,
these programs vary greatly from State to State--from the populations
they serve, to the reporting mechanisms they use, and the budget
structures under which they operate. These discrepancies, which
continue to be exacerbated by the absence of Federal APS funding,
necessarily impede efforts to compare, evaluate, and improve State
approaches to reducing and preventing elder abuse.
To address the systemic inadequacies in our Nation's approach to
eradicating elder abuse, neglect, and exploitation, we urge you to
support ACL's request of $25 million in discretionary funding to
implement the EJA in fiscal year 2015. This critical funding would be
used to develop much-needed program standards and data collection
efforts, as well as to support the implementation of a nationwide APS
data system; these dollars would also fund research activities,
including efforts to translate promising interventions from other
violence prevention areas to elder abuse, and evaluations of the
effectiveness of these interventions.
NASUAD believes that efforts to improve the response to, awareness
of, and intervention in elder abuse, neglect, and exploitation could be
more effectively coordinated through the establishment of a national
APS program. Accordingly, we urge you to fully fund the Elder Justice
Initiative in fiscal year 2015.
Thank you for the opportunity to provide input on this critical
issue, and for your leadership. NASUAD looks forward to working with
all of you to preserve the dignity, independence, and health of older
adults, and to protect those who may no longer be able to protect
themselves.
______
Prepared Statement of the National Blood Clot Alliance
The National Blood Clot Alliance (NBCA) is pleased to submit this
statement in support of increased appropriations for fiscal year 2015
for the Centers for Disease Control and Prevention's (CDC) Division of
Blood Disorders, a component of CDC's National Center on Birth Defects
and Developmental Disabilities. NBCA's statement addresses the programs
specific to blood clots, known scientifically as Deep Vein Thrombosis
(DVT) and Pulmonary Embolism (PE), a major public health problem facing
this Nation. Combined, these disorders are known as venous
thromboembolism (VTE). Preventing death and disability from VTE is an
important public health priority, and the Division is responsible for
all CDC activities related to blood clots and other bleeding disorders.
NBCA asks the Subcommittee to restore funding for the Division to
its fiscal year 2010 level, $19.9 million. The fiscal year 2014 funding
has dropped precipitously to $13 million. Of this, support for blood
clot prevention has been cut in half, to a mere $560,000, hardly enough
to make a dent in a major public health problem that annually kills
more Americans than AIDS, breast cancer and motor vehicle accidents
combined. NBCA further requests that the Subcommittee establish a
budget line item specific to blood clots and clotting disorders and
that $4 million be appropriated for this line each year for the next 5
years.
Funding this program at the requested level will be a major step in
advancing the Surgeon General's 2008 ``Call to Action to Prevent Deep
Vein Thrombosis (DVT) and Pulmonary Embolism (PE)'' and the Nation's
``Healthy People 2020 Objectives.'' The urgency of this request is
underscored by the fact that the great majority of blood clots could be
prevented. We have the tools to do that, but the resources to deploy
them are woefully inadequate.
Blood clots are the leading cause of unnecessary hospital
readmissions in the U.S., costing our Nation an estimated $10 billion
dollars in avoidable healthcare expenses annually. According to the
American Public Health Association, DVT deaths are the most common
preventable cause of hospital death. Researchers at Johns Hopkins
University School of Medicine recently reported that as many as 70
percent of healthcare associated VTE could be eliminated with the
application of improved prevention protocols. Other targeted
population-based prevention tools can be applied to avert disability
and death from blood clots due to aging, lengthy travel, immobility,
obesity and other risk factors.
The National Blood Clot Alliance
Founded in 2003, NBCA is a patient led non-profit, voluntary health
organization dedicated to advancing the prevention, early diagnosis and
successful treatment of life-threatening blood clots such as deep vein
thrombosis, pulmonary embolism and clot-provoked stroke. We work on
behalf of people who have or could be susceptible to blood clots,
including, but not limited to, people with clotting disorders, atrial
fibrillation, cancer, traumatic injury, and risks related to surgery,
lengthy immobility, child birth and birth control. NBCA accomplishes
its mission through programs that build public awareness, educate
patients and healthcare professionals and promote supportive public and
private sector policy. Our content is reviewed by an internationally
recognized Medical and Scientific Advisory Board. We invite the Members
of the Subcommittee to visit our website at www.stoptheclot.org to
learn more about blood clots and the programs of NBCA.
Who Has Blood Clots and What Are They?
No American is immune from life-threatening blood clots, regardless
of age, gender, race, ethnicity or health status. Normal blood clots
play an important role in protecting our health because they stop
bleeding from a cut or wound. However, blood clots can also form
abnormally, causing a heart attack, stroke, or other serious medical
problems. Experts estimate that two million Americans suffer such
venous and arterial blood clots every year. More than 200,000 Americans
die from them annually. An often silent killer, death can be sudden
with no forewarning. But in most instances, the damage can be averted
or contained. Age, smoking, obesity can all contribute to clotting
risk, but so can birth control or pregnancy or cancer. Even prominent
athletes in peak physical condition have suffered career- ending, life
-threatening clots. It can happen to any of us. In fact, the memories
of former U.S. Reps. Walter Capps (D-CA) and Jennifer Dunn (R-WA), who
died due to blood clots while serving in Congress, motivated the
creation of National Blood Clot Awareness Month in March of 2009.
Physicians estimate that as little as 20 percent of blood clots are
actually recognized for what they are. Misdiagnosis and delayed
diagnosis are all too common and all too often fatal. The general
public is even farther behind, with surveys showing that nearly three
quarters of the population has little or no knowledge about blood
clots, their risks, their signs and symptoms and their prevention. The
Government must play a greater role in educating the general public,
people who are at special risk and health professionals. This is the
``low hanging fruit'' of public health prevention that has yet to be
adequately picked and the return on invest can be tens of thousands of
lives saved and billions of dollars in unnecessary healthcare expenses
avoided!
The Federal Government Has a Vital Role in Meeting this Acknowledged
Public Health Priority
Many Federal agencies play important roles in the effort to reduce
death and disability from blood clots and clotting disorders. The
National Institutes of Health and the National Science Foundation
support the work of basic scientists in their efforts to understand the
causes and effects of blood clots and identify improved treatments. The
VA also supports research in this field and strives to prevent blood
clots in the special population of Americans it serves. The Agency for
Healthcare Research and Quality in 2001 was among the first to
recognize that blood clot prevention in hospitals was our best
opportunity for patient safety improvement. The Partnership for
Patients makes made blood clot prevention a key component of improved
hospital care. CMS includes surgery-related blood clot prevention as a
key measure of hospital quality. DOD has examined how blood clots can
be prevented in the military, affecting soldiers who must often live in
cramped conditions, suffer dehydration and experience bone fractures
and more severe injuries that require surgery.
Each of these agencies plays a special role in the effort to reduce
clotting death and injury. However, the CDC, the Nation's leading
prevention agency, is the one best suited to guide and coordinate
Federal efforts targeted at populations more broadly. No other agency
possesses its unique capabilities in public health outreach, education
and promotion. Regrettably the agency best suited for leadership is the
one with the fewest resources. NBCA believes it is imperative that
Congress act now to provide adequate, sustained funding for this
specific activity at CDC--the reduction of death and disability due to
blood clots.
The funding request presented at the beginning of this statement
will provide CDC with the resources it needs to begin seriously to meet
this public health challenge. fiscal year 2014 funding for blood clot
programs is only $560,000, half of what was available in the last
fiscal year. The Administration's proposed fiscal year 2015 budget
would make no change to this level. The current funding situation for
the Blood Disorders Division has already forced CDC to cut or curtail
the few programs it has been able to support. These include two pilot
programs to improve community-based VTE surveillance and evaluation;
one focused on healthcare provider education; one targeted at women's
health (e.g., blood clots are the leading cause of maternal mortality);
and a collaboration with the VA and academia to develop new VTE
surveillance tools. Staffing of the Division has also been cut nearly
in half, decreasing by 18 FTEs, including essential personnel with
specialized laboratory, IT and analytic skills. At a time when this
public health problem is growing, we have allowed even the small
investment in CDC to address it become further negligible. This is
neither thoughtful public policy nor wise economically.
NBCA believes that our citizens deserve better and that Federal
support for this acknowledged public health priority should be equal to
the task. Tragically, it is not at present. NBCA urges the Subcommittee
to take the lead in making the changes needed to provide CDC with the
funds it needs to combat this major public health issue--blood clots,
clotting disorders and the ensuing disability that consumes far too
many lives and dollars in the U.S. unnecessarily.
[This statement was submitted by Joseph C. Isaacs, Chief Executive
Officer, National Blood Clot Alliance.]
______
Prepared Statement of the National Center for Learning Disabilities
The National Center for Learning Disabilities (NCLD) works to
ensure that the Nation's 60 million children, adolescents and adults
with learning disabilities and attention issues have every opportunity
to succeed in school, work and life. NCLD asks you to consider our
request as you work on the fiscal year 2015 Labor, Health and Human
Services, and Education Appropriations bill.
As you begin work on the fiscal year 2015 Labor, Health and Human
Services, and Education Appropriations bill, we urge you to support
continued funding for special education at the President's request
level of $11.57 billion for the Individuals with Disabilities Education
Act (IDEA) and the President's $100 million for Results Driven
Accountability Incentive Grants which would provide competitive grants
to States to implement promising, evidence-based reforms that would
improve service delivery for children with disabilities while building
State and local capacity to improve long--term outcomes for those
children
We also urge you to support funding for the National Technical
Assistance Center within the Higher Education Opportunity Act (Section
777(a)) at $2 million to provide useful and comprehensive information
to students with disabilities on the choices available to them in
higher education and to provide much-needed training, technical
assistance, and professional development to institutes of higher
education.
IDEA Part B Grants to States & Results Driven Accountability Incentive
Grants
Currently, there are over 6.5 million children eligible for special
education services under the disability categories of the Individuals
with Disabilities Education Act (IDEA). The comprehensive assessment
and support services authorized by IDEA help to close the academic
achievement gap and ensure a meaningful education for every student. We
owe it to all students to provide a quality education that will help
them graduate and enter successful careers.
We support the Administration's request that would maintain funding
for IDEA, Part B (Grants to States program) at $11.57 billion, which
the Administration estimates would provide $1,758 per child for an
estimated 6.6 million students with disabilities. Additionally we
support the President's $100 million for Results Driven Accountability
Incentive Grants, which would provide competitive grants to States to
implement promising, evidence-based reforms that would improve service
delivery for children with disabilities. We encourage innovation in the
realm of service delivery to students receiving special education and
believe that these grants have the potential to spark innovative ideas
and a renewed focused on improved outcomes for students.
The National Technical Assistance Center
In the HEA reauthorization of 2008, Congress authorized the
establishment of National Center for Information and Technical Support
for Postsecondary Students with Disabilities. This Center was intended
to serve three primary purposes: (1) serve as a resource to parents and
students with disabilities on the services available at various IHEs;
(2) serve as a technical assistance center to IHEs and provide training
to faculty and staff on how to improve services for students with
disabilities; and (3) serve as an online database for the collection
and dissemination of a variety of disability-related information for
students with disabilities who are interested in higher education.
Though the Center was authorized, it has never been funded.
How Students with Disabilities are Faring in Higher Education
In recent years, due to the services provided to students with
disabilities through the Individuals with Disabilities in Education Act
(IDEA) or Section 504 of the Rehabilitation Act, students with learning
and attention issues have graduated from high school at higher rates
than ever before. In fact, a majority (54 percent) of students with
learning disabilities have the goal to attend a 2- or 4-year
college.\1\ Students with learning disabilities make up the largest
population of students with disabilities who attend postsecondary
schools, at 69 percent of all students with disabilities in
postsecondary programs.\2\
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\1\ Cortiella, Candace and Horowitz, Sheldon H. The State of
Learning Disabilities: Facts, Trends and Emerging Issues. New York:
National Center for Learning Disabilities, 2014.
\2\ Newman, L.A. & Madaus, J. W. (2013). Reported Accommodations
and Supports Provided to Secondary and Postsecondary Students with
Disabilities: National Perspective. Publication forthcoming.
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Unfortunately, students with disabilities are not attending
postsecondary education programs at the same rate as students in the
general population. In the general education population, within 4 years
of graduating high school, 53 percent of students continue on to
postsecondary education programs, compared to only 45 percent of youth
with disabilities. Even worse, young adults with learning disabilities
(LD) attend four-year colleges at half the rate of the general
population.\3\ Students with disabilities would benefit from better
outreach, recruitment, and assistance programs to bridge the gap
between high school and postsecondary education programs. Comprehensive
information on higher education programs and services is needed now
more than ever. With more students with disabilities setting goals of
attending college but few actually enrolling and completing college
programs, it is critical that they have access to the information and
support services they need.
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\3\ Cortiella & and Horowitz (2014).
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The Lack of Comprehensive Information on Post-Secondary Education
Programs
The U.S. Department of Education (ED) has made efforts to improve
parent and student access to timely and useful information regarding
colleges and universities through the development of the College
Navigator. The Department of Education collects data from IHEs through
Integrated Postsecondary Education Data System (IPEDS) surveys,
including data on enrollment, program completion, graduation rates,
faculty and staff, finances, institutional prices, and student
financial aid. The data is made available to students and parents via
College Navigator--a public website that allows users to perform a
search of colleges. The data and information provided through the
College Navigator--has the potential to support and improve rates of
transition for all young adults from high school into the postsecondary
setting. However, this information alone is not enough to ensure a
smooth transition for students with disabilities into their
postsecondary education programs.
NCLD has conducted its own survey of the information provided by
IHEs on College Navigator. College Navigator provides a place for every
IHE to provide information on the disability services offered at the
institution. We examined the responses that nearly 400 institutions
submitted, including private, public, and for profit institutions as
well as community colleges. Only 6 of the institutions surveyed listed
any information to students and the public regarding disability
services.\4\
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\4\ For more information on the survey conducted by NCLD and the
IHEs we surveyed to find this data, please contact us.
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The Need for a Smoother Transition to Post-Secondary Programs
Research shows that students with disabilities are getting less
support in college than in high school, despite wishing they had more
assistance. Even though 87 percent of students with disabilities
received some type of accommodation or support in high school, that
number drops off sharply when students with disabilities enter college,
decreasing to only 19 percent of students who receive accommodations or
support.\5\ For students with learning disabilities, 17 percent of
young adults receive accommodations and supports in postsecondary
education compared with 94 percent in high school.\6\ Of the many
students who did not receive any help at all, 43 percent felt that it
would have been helpful to receive assistance.\7\ We know that self-
advocacy is one of the keys to student success, but it is clear that
students are not aware of their rights and responsibilities, are not
adequately prepared to advocate for themselves, and are not provided
adequate transition assistance to be successful in postsecondary
education programs.
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\5\ Newman, L., Wagner, M., Knokey, A.-M., Marder, C., Nagle, K.,
et al. (2011). The PostHigh School Outcomes of Young Adults With
Disabilities up to 8 Years After High School. A Report From the
National Longitudinal Transition Study-2 (NLTS2) (NCSER 2011-3005).
Menlo Park, CA: SRI International.
\6\ Cortiella & and Horowitz (2014).
\7\ Newman, Wagner, Knokey, Marder, et al. (2011).
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The Purpose of the National Technical Assistance Center
We recognize that providing useful and comprehensive information to
parents and students on the choices available is not an easy task.
Therefore, we recommend funding the National Technical Assistance
Center, found in the 2008 authorization of HEA, at $2 million. The
Center would serve several key purposes: (1) providing information and
resources to students and parents on disability services and programs
at IHEs; (2) providing training and technical assistance to IHEs; (3)
providing training and professional development to faculty and staff at
IHEs; and (4) information collection and dissemination on best
practices, documentation requirements, financial aid, services
available, policies, and accessible instructional materials.
We urge you to continue your investment in students with
disabilities through funding of IDEA and the RDA grants and support
funding in fiscal year 2015 for the National Technical Assistance
Center. Thank you for your consideration of our request.
[This statement was submitted by Lindsay E. Jones, Esq., Director,
Public Policy & Advocacy, National Center for Learning Disabilities.]
______
Prepared Statement of the National Children's Facilities Network
Chairman Harkin, Ranking Member Moran, and distinguished Members of
the Appropriations Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies: Thank you for the opportunity to offer
written testimony on the Administration's fiscal year 2015 Budget
Request for the Department of Health and Human Services, Administration
for Children and Families. I write on behalf of the National Children's
Facilities Network (NCFN) to express support for the funding of Head
Start, Early Head Start-Child Care Partnerships and other programs that
provide access to high quality early care and education. These
initiatives are critical to ensuring that all children, especially low-
income children, are given a strong start and the tools necessary to
succeed in life. As you make important funding decisions about programs
that provide children with the opportunity to obtain an early start on
the pathway to success, we encourage you to recognize the critical role
that early childhood facilities play in preparing young children for
achievement in school and in life, and support Federal policies that
adequately finance the acquisition, construction, and improvement of
these spaces.
NCFN is a national coalition of nonprofit organizations that
provide financing, technical assistance and training on the design,
development and financing of early care and education facilities in
low-income communities throughout the country. We see the positive
impact of high quality early learning on children's lives and on the
future economic health and development of neighborhoods. Our coalition
also recognizes the importance of the spaces where these programs take
place. A growing body of research shows that a well-designed, well-
equipped physical environment supports learning and good outcomes for
children, while a poorly adapted and overcrowded space undermines it.
For example, bathrooms adjacent to classrooms, accessible cubbies, and
child-sized sinks, counters, furnishings and fixtures increase
children's autonomy and competence while decreasing the demands on
teachers.
Infants, toddlers, and young children should be educated and cared
for in high quality physical spaces that meet their needs and
complement high quality programs. Federal programs focused on improving
families' access to high quality early care and education options
should include adequate funding for the acquisition, construction, and
improvement of facilities.
Thank you for your leadership on these issues. Please consider us
as a resource as you advance early childhood policies. If you would
like additional information about our work, please contact Karen
O'Mansky, Center for Community Self-Help, Chair, National Children's
Facilities Network.
______
Prepared Statement of the National Congress of American Indians
On behalf of the National Congress of American Indians (NCAI), this
testimony addresses programs in the Departments of Education and Labor
and the Corporation for Public Broadcasting. NCAI also supports the
testimony of the National Indian Child Welfare Association, the
American Indian Higher Education Consortium, and the National Indian
Education Association. NCAI is the oldest and largest American Indian
organization in the United States. Tribal leaders created NCAI in 1944
as a response to termination and assimilation policies that threatened
the existence of American Indian and Alaska Native tribes. Since then,
NCAI has fought to preserve the treaty rights and sovereign status of
tribal governments, while also ensuring that Native people may fully
participate in the political system. As the most representative
organization of American Indian tribes, NCAI serves the broad interests
of tribal governments across the Nation.
Department of Education
Investing in the education of American Indian and Alaska Native
students is not only one most of the most important cornerstones of the
Federal trust responsibility to tribes, but is also critical strategy
for creating jobs and securing the Nation's future prosperity in
today's challenging economic climate. Education provides tribal
economies with a more highly-skilled workforce while also directly
spurring economic development and job creation. The profound value of
education for Native Nations extends beyond just economics, however.
Education drives personal advancement and wellness, which in turn
improves social welfare and empowers communities--elements that are
essential to maintaining tribes' cultural vitality and to protecting
and advancing tribal sovereignty.
Despite the enormous potential of education for transforming tribal
communities, Native education is in a state of emergency. American
Indian and Alaska Native students lag far behind their peers on every
educational indicator, from academic achievement to high school and
college graduation rates. For example, in 2011, only 18 percent of
Native fourth graders and 22 percent of Native eighth graders scored
proficient or advanced in reading, and only 22 percent of Native fourth
graders and 17 percent of Native eighth graders scored proficient or
advanced in math.\1\ The crisis of Indian education is perhaps most
apparent in the Native high school dropout rate, which is not only one
of the highest in the country, but is also above 50 percent in many of
the States with high Native populations.\2\
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\1\ National Indian Education Study 2011, NCES 2012-466. National
Center for Education Statistics, Institute of Education Sciences,
United States Department of Education.
\2\ School Year 2010-2011 4-Year Regulatory Adjusted Cohort
Graduation Rates, Department of Education.
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Title I, Part A Local Education Agency Grants--Provide $25 billion
for Title I, Part A.--Title I of the Elementary and Secondary Education
Act provides critical financial assistance to local educational
agencies and schools with high percentages of children from low-income
families that ensure all children meet challenging State academic
standards. Currently, there are over 600,000 Native students across the
country with nearly 93 percent of those students attending non-Federal
institutions, such as traditional public schools in rural and urban
locations. A drastic increase in funding to counter annual inflation
and sequestration is necessary to meet the needs of Native students and
students from low-income families.
Impact Aid--Provide $2 billion for Impact Aid, Title VIII of the
Elementary and Secondary Education Act (ESEA).--Impact Aid provides
direct payments to public school districts as reimbursements for the
loss of traditional property taxes due to a Federal presence or
activity, including the existence of an Indian reservation. With nearly
93 percent of Native students enrolled in public schools, Impact Aid
provides essential funding for schools serving Native students. In
fiscal year 2014, Impact Aid saw an increase of $64 million over fiscal
year 2013 that restored most of the destructive sequestration cuts
tribal communities faced in Indian Country. In order to ensure Native
students have access to education, however, Impact Aid must be fully
funded at $2 billion. Furthermore, Impact Aid should be converted to a
forward-funded program to eliminate the need for cost transfers and
other funding issues at a later date.
Title VII (Indian Education Formula Grants)--Provide $198 million
for Title VII of the ESEA.--This grant funding is designed to
supplement the regular school program and assist Native students so
they have the opportunity to achieve the same educational standards and
attain equity with their non-Native peers. Title VII provides funds to
school divisions to support American Indian, Alaska Native, and Native
Hawaiian students in meeting State standards. Furthermore, Title VII
funds support early-childhood and family programs, academic enrichment
programs, curriculum development, professional development, and
culturally-related activities. Currently, funding for Title VII only
reaches 500,000 Native students leaving over 100,000 without
supplementary academic and cultural programs in their schools.
State-Tribal Education Partnership (STEP) Program--Provide $5
million for the State-Tribal Education Partnership Program..--Congress
appropriated roughly $2 million dollars for the STEP program to five
participating tribes in fiscal year 2012 and fiscal year 2013 under the
Tribal Education Department appropriations' line that is administered
by the Department of Education. In order for this program to continue
to succeed and thrive, it must receive its own line of appropriations
in fiscal year 2015. Collaboration between tribal education agencies
and State educational agencies is crucial to developing the tribal
capacity to assume the roles, responsibilities, and accountability of
Native education departments and increasing self-governance over Native
education.
Alaska Native Education Equity Assistance Program--Provide $35
million for Title VII, Part C of the ESEA.--This assistance program
funds the development of curricula and education programs that address
the unique educational needs of Alaska Native students, as well as the
development and operation of student enrichment programs in science and
mathematics. This funding is crucial to closing the gap between Alaska
Native students and their non-Native peers. Other eligible activities
include professional development for educators, activities carried out
through Even Start programs and Head Start programs, family literacy
services, and dropout prevention programs.
Native Hawaiian Education Program--Provide $35 million for Title
VII, Part B of the ESEA.--This program funds the development of
curricula and education programs that address the education needs of
Native Hawaiian students to help bring equity to this Native
population. Where Native Hawaiians once had a very high rate of
literacy, today Native Hawaiian educational attainment lags behind the
general population.
Department of Labor
Fund the Department of Labor's Indian and Native American Program
(INAP) at a minimum of $60.5 million. Fund the Native American
Employment and Training Council at $125,000 from non-INAP resources.--
In order to reduce the education and employment disparity between
Native people and other groups, a concentrated effort is required that
provides tailored and sufficient assistance to enhance education and
employment opportunities, to create pathways to careers and skilled
employment, and to secure a place for Native people within the Nation's
middle class. The Workforce Investment Act (WIA) Section 166 program
(INAP) serves the training and employment needs of over 38,000 American
Indians and Alaska Natives via a network of 175 grantees through the
Comprehensive Service Program (Adult) and Supplemental Youth Service
Program (Youth), and the Indian Employment and Training and Related
Services Demonstration Act of 1992, Public Law 102-477. Furthermore,
the number of American Indians and Alaska Natives served through WIA
does not fully capture its impact in Indian Country, as many more are
served by grantees that leverage WIA funding, along with other similar
federally funded employment and training programs, through PL 102-477.
There has been a trend of decreasing funds for INAP, and a failure
to appropriate at the statutory minimum level of $55 million. These
decreases in funding are detrimental and hamper progress in Indian
Country's labor situation. According to the Census, the average
unemployment rate on reservations dropped more than 3 percentage points
since 2000,\3\ but more still needs to be done as American Indians and
Alaska Natives still lag significantly behind. With the average
unemployment rate in Indian Country cited up to 17 percent \4\ and an
average rate of joblessness of approximately 50 percent,\5\ INAP is
vital to helping reverse these trends.
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\3\ U.S. Census Bureau. Census 2000 Summary File 4, 2006-2010,
2009-2011 American Community Survey.
\4\ U.S. Census. 2011 American Community Survey.
\5\ U.S. Department of Interior. Bureau of Indian Affairs. 2005
American Indian Labor Force Report.
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Further, because INAP is the only Federal employment and job
training program that serves American Indians and Alaska Natives who
reside both on and off reservations, it is imperative that its funding
is preserved. For Native citizens living on remote reservations or in
Alaska Native villages, it can be difficult to access the State and
local workforce systems. In these areas, INAP can be the lone
employment and training provider. Since 2003, WIA has been up for
reauthorization; and over this 11-year period, WIA has not accounted
for the population growth of tribal communities, nor the economic
environment that has drastically changed. WIA authorizes the INAP to be
funded at ``not less than $55 million,'' but Section 166 is currently
being funded at approximately $46 million. WIA also authorizes the
Native American Employment and Training Council to advise the Secretary
on the operation and administration of INAP, but it uses funds that are
intended for INAP grantees. Since the current INAP funding is already
below $55 million, the Secretary should use other streams of funding to
support its advisory council. Without an increase in funding, not
enough tribes are able to benefit from the support and training
activities for employment opportunities in Indian Country.
Restore the YouthBuild Program funding to a minimum of $102.5
million, restore the rural and tribal set-aside in the YouthBuild
program, and reinstate a dedicated 10 percent rural and tribal set-
aside of at least $10.25 million.--The YouthBuild program is a
workforce development program that provides significant academic and
occupational skills training and leadership development to youth ages
16-24, and engages approximately 10,000 youth annually. According to
YouthBuild, in 2010, 4,252 youth participated in the program and had a
completion rate of 78 percent, and 60 percent of those who completed
the program were placed in jobs or further education.\6\ There are a
number of tribal YouthBuild programs in several States, and Native
Americans make up roughly 4 percent of YouthBuild participants. With
the recent reduction in tribal YouthBuild programs, high unemployment
rates, serious housing challenges in Indian Country, and the growing
Native youth population (42 percent of American Indian/Alaska Native
population is under 25 years old),\7\ it is critical that the 10
percent rural and tribal set- aside be restored.
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\6\ See youthbuild.org/research.
\7\ U.S. Census Bureau, 2010 Census, Summary File 1.
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Corporation for Public Broadcasting
In the CPB, NCAI supports an advanced fiscal year 2016
appropriation of $5 million for American Indian and Alaska Native radio
stations. This $5 million appropriation would come out of the fiscal
year 2015 advanced appropriation of $445 million for the overall CPB
budget. This is the same budget amount enacted for fiscal year 2014 and
requested for fiscal year 2015.
For more than 30 years, decisions on the amount of Federal support
for public broadcasting have been made 2 years ahead of the fiscal year
in which the funding is allocated. Since 1976, CPB's 2-year advance
appropriation has served as a Congressional strategy to protect public
media from any immediate political pressure. Community Service Grants
(CSGs) account for approximately 70 percent of CPB's appropriation,
which directly funds 1,300 local public television and radio stations
including 35 Native radio stations.
In Indian Country, Native radio stations are essential to the
tribal communities they serve since they are often the first source of
emergency reporting and information. Public broadcasters use datacast
technology for homeland security, public alert and warning systems, and
public safety purposes. In Oklahoma, KCNP Chickasaw radio provided real
time weather reports that saved lives during the 2013 tornado season.
In Arizona, KUYI Hopi radio provides ``House Calls,'' a health call-in
show that connects listeners with a local doctor on questions about
hanta virus, diabetes, HIV, and other local health issues. In Alaska,
KNBA covers news from Alaska Native villages about climate change
refugees, language revitalization, and other hyper local stories
important and relevant to Alaska Native communities. Often, the only
place where Native stories and issues are heard is on Native radio
stations.
Local public media stations and their employees have experienced
significant reductions through cuts to other Federal programs that
benefit public media. The elimination of CPB's Digital appropriation
and the Public Telecommunications Facilities Program coupled with cuts
to programs at the Departments of Education and Agriculture represent a
$57.5 million, or 7.3 percent, funding cut between fiscal year 2010 and
fiscal year 2012. These cuts come at a time when stations are
struggling to maintain service to their communities in the face of
shrinking nonFederal revenues--a $239 million, or 10.8 percent, drop
between fiscal year 2008 and fiscal year 2011.
CPB also funds the essential system-wide station support services
provided by Native Public Media, Inc., and content production and
satellite programming distribution by Koahnic Broadcast Corporation.
Access to these funds allows Native Public Media, Inc., to ensure that
Native radio stations stay on the air by maintaining compliance with
FCC and other Federal rules and regulations, and by providing the
training and support Native broadcasters need. Native public radio
stations still exist as one of the primary sources of public
information on tribal lands, and represent cornerstones of tribal
efforts for information dissemination. Much of Indian Country remains
disconnected from vital telecommunications services, radio should not
be counted among them. Radio has always existed as a key component of
public information and 55 tribal radio stations among this country's
566 federally recognized tribes illustrates the need for these services
in Indian Country.
______
Prepared Statement of National Council of Social Security Management
Associations
On behalf of the National Council of Social Security Management
Associations (NCSSMA), thank you for the opportunity to submit this
testimony regarding the Social Security Administration's (SSA's) fiscal
year 2015 Appropriation.
NCSSMA is a membership organization of nearly 3,300 SSA managers
and supervisors who provide leadership in over 1,200 community-based
field offices and teleservice centers throughout the country. We are
the front-line service providers for SSA in communities all over the
Nation. Since the founding of our organization over 44 years ago,
NCSSMA has considered a stable SSA, which delivers quality and timely
community-based service to the American public, our top priority. We
also consider it a top priority to be good stewards of the taxpayers'
monies and the Social Security programs we administer.
We would like to express our appreciation for the fiscal year 2014
Limitation on Administrative Expenses (LAE) account funding of $11.697
billion provided to SSA. Increased resources, especially in SSA's field
offices and teleservice centers, will have a positive impact on
delivering vital services to the American public and in fulfilling the
agency's stewardship responsibilities. Since October 2010, SSA field
offices had lost almost 4,100 permanent employees prior to the first
wave of fiscal year 2014 hiring. The teleservice centers (TSCs) lost
1,159 employees during the same timeframe. For the first time in over 3
years, we are replacing some of these losses. Because of the fiscal
year 2014 funding, authority was granted to field offices and
teleservice centers to hire 2,350 and 850 permanent employees,
respectively. In addition, 550 permanent hires were approved for
Workload Support Units (WSUs) that are expected to ease the burden
placed on field offices.
The dramatic growth in SSA workloads, along with the attrition in
our offices over the last several years, has highlighted the need to
receive necessary resources to maintain service levels vital to the
nearly 65 million Social Security beneficiaries and Supplemental
Security Income (SSI) recipients. Despite agency strategic planning,
expansion of online services, significant productivity gains, and the
best efforts of management and employees, SSA still faces many
challenges providing the service the American public has earned and
deserves.
Over the last several years, SSA has experienced a significant
increase in Social Security claims. The additional claims receipts are
driven in large part by the initial wave of the nearly 80 million baby
boomers who will be filing for Social Security benefits by 2030, an
average of 10,000 per day.
--In fiscal year 2013, SSA field offices assisted 43.3 million
visitors, received 4.9 million retirement, survivor and
Medicare applications, and 2.9 million initial disability
claims.
--In fiscal year 2013, SSA completed 2,987,883 initial disability
claims. Since fiscal year 2007, initial disability claims
receipts have increased by over 25 percent.
--In fiscal year 2013, SSA completed 5,006,855 retirement, survivor,
and Medicare claims (5,001,092 in fiscal year 2012)--a record
number and over a million more than completed in fiscal year
2007.
--In fiscal year 2013, retirement, survivor, and Medicare claims were
30 percent higher as compared to fiscal year 2007.
--Each day over 155,000 people visit SSA field offices and more than
436,000 call SSA for a variety of services.
We fully support the President's budget request of $12.024 billion
for SSA's LAE account in fiscal year 2015. While this would be a much-
appreciated increase of $327 million over the fiscal year 2014 level of
funding, it would only address fixed cost increases. The fiscal year
2015 Budget Request submitted by Acting Commissioner Carolyn Colvin to
President Obama for SSA's administrative funding was $12.6 billion.
This level of funding will allow SSA to continue improving and
modernizing customer service, enhance program integrity efforts, detect
and deter fraud and errors, and continue to address high volumes of
work. In November of 2013, NCSSMA co-authored a letter with 29 other
organizations, which was submitted to the Office of Management and
Budget (OMB) and recommended a funding level consistent with the Acting
Commissioner's request for SSA's administrative funding. Specifically
the letter stated:
SSA teleservice centers, hearing offices, program service centers,
disability determination services (DDS), and field offices are
in critical need of adequate resources to address their growing
workloads. The recommended fiscal year 2015 budget of no less
than $12.6 billion would allow SSA to cover inflationary
increases, resume efforts to reduce hearings and disability
backlogs, complete deficit-reducing program integrity work, and
replace critical staffing losses in SSA's components, including
field offices, teleservice centers, and DDSs.
Adequate funding would also help to minimize the closure of
additional field offices. Since fiscal year 2010, SSA
consolidated 92 field offices into 46 field offices and closed
521 contact stations. The agency also cancelled plans to open
eight new hearing offices and a new teleservice center due to
limited resources. In many cases, applicants for benefits or
those approaching retirement age who have questions about their
eligibility or benefits have been forced to travel greater
distances to visit a Social Security field office.
The fiscal year 2014 appropriation for SSA provided $1.197 billion
dedicated to program integrity activities to ensure that disability and
other benefits are properly paid. SSA plans to process 2.6 million SSI
redeterminations and 510,000 full medical continuing disability reviews
(CDRs) in fiscal year 2014. Despite these efforts, the agency continues
to have 1.3 million CDRs backlogged due to budgetary shortfalls. The
fiscal year 2015 budget request would provide $1.396 billion dedicated
to program integrity. With these funds, the agency would be able to
complete 880,000 full medical CDRs and 2.6 million SSI
redeterminations. Completing more than 880,000 CDRs would more than
double the CDRs completed in 2013, saving billions of taxpayer dollars.
While it is critical SSA focus on cost-effective program integrity
work to protect taxpayer dollars, there must be a balance between these
efforts, preventing fraud and improper payments before they occur, and
service to the American public. One way we can help stop fraud before
it starts is through the work of Cooperative Disability Investigation
(CDI) units. With the increased fiscal year 2014 funding, SSA will be
able to add 7 units to the existing 25. We recognize CDI unit expansion
is not enough and advocate for additional focus on program integrity
initiatives including providing in-depth training for identifying and
reporting fraud for our front-line employees. Field office employees
are the first line of defense against fraud, and must have the training
and resources necessary to identify and report questionable activities
and claims. Additional training initiatives have begun in fiscal year
2014, but must continue.
SSA is challenged by ever-increasing workloads, very complex
programs to administer, and increased program integrity work with
diminished staffing and resources. With the current fiscal challenges
confronting SSA, we encourage Congress to consider changes to the
Social Security and SSI programs that have the potential to increase
administrative efficiency and lower operational costs.
It is critical SSA receives adequate, yet flexible funding for the
LAE account to respond to requests for assistance from the American
public, and to fulfill our stewardship responsibilities. SSA TSCs,
hearing offices, program service centers (PSCs), DDS, and the over
1,200 field offices are in grave need of adequate resources to address
their growing workloads. Many of SSA's field offices are currently
experiencing wait times in excess of 60 minutes. One out of every 8
visitors waits more than 1 hour to receive services, which is 177
percent more than in fiscal year 2012 and 224 percent more than fiscal
year 2011. Without adequate funding, SSA will not be able to provide
the high-quality customer service Americans deserve and will be unable
to process program integrity workloads, which save taxpayer dollars and
reduce the Federal budget and deficit.
We realize the fiscal year 2015 funding level requested above is
not insignificant, particularly in this difficult Federal budget
environment. However, Social Security serves as the largest most vital
component of the social safety net of America and is facing
unprecedented challenges. The American public expects and deserves
SSA's assistance.
On behalf of NCSSMA members nationwide, thank you for the
opportunity to submit this written testimony. We respectfully ask that
you consider our comments, and would appreciate any assistance you can
provide in ensuring the American public receives the critical and
necessary service they deserve from the Social Security Administration.
[This statement was submitted by Scott Hale, President, National
Council of Social Security Management Associations.]
______
Prepared Statement of the National Energy Assistance Directors'
Association
The members of the National Energy Assistance Directors'
Association (NEADA), representing the State directors of the Low Income
Home Energy Assistance Program (LIHEAP) would first like to take this
opportunity to thank the members of the Subcommittee for considering
our funding request for fiscal year 2015 and advance funding for fiscal
year 2016.
We would also like to thank the members of the Committee for
increasing the funding for fiscal year 2014. These additional funds
allowed States to increase grants for low income families to help them
pay a portion of their higher home heating costs during this year's
bitterly cold winter. The additional funds will also allow States to
maintain at least a minimal level of support for cooling programs this
summer.
Purchasing Power of LIHEAP Continues to Decline
The increase in program funding in fiscal year 2014, however, was
not sufficient to stem the continuing decline in the purchasing power
of the average LIHEAP grant. Since fiscal year 2010, the purchasing
power of the average grant has declined from 60.2 percent of the cost
of home heating to 44.7 percent. In other words, in fiscal year 2010,
the average grant could purchase approximately 72 days of home heating,
whereas in fiscal year 2014, the average grant could only purchase 54
days of home heating.
The program's purchasing power is declining for two reasons:
--First and foremost is the decline in the program's appropriation.
Between fiscal year 2010 and fiscal year 2013, LIHEAP's annual
appropriation declined from $5.1 billion to $3.25 billion. As a
result, during this time States were forced to reduce the
average grant from $520 to $398 and the number of households
served from 8.1 million to 6.7 million. The increase in funding
in fiscal year 2014 to $3.4 billion allowed States to increase
the average grant by $21 to $419, still almost $100 less than
the average grant awarded in fiscal year 2010.
--Second, average home heating costs increased from $796 during the
winter heating season of 2011--12 (fiscal year 2012) to $936
during this recent winter heating season. During this period,
the average increase for those using natural gas went from $567
to $663; for electricity, from $840 to $934; for heating oil,
from $1,735 to $2,243; and for propane, from $1,563 to $2,269.
LIHEAP is the primary source of heating and cooling assistance for
some of the poorest families in the United States. In fiscal year 2014,
the number of households receiving heating assistance is expected to
remain at about 6.7 million households, or about 19 percent of those
eligible to receive assistance. In addition, the program is expected to
reach about 600,000 households for cooling assistance, the same level
that received assistance in fiscal year 2013.
President's Budget Would Severely Reduce the Number of Households
Served
The President's fiscal year 2015 Budget request for LIHEAP would
result in even greater cuts to the program's effectiveness by reducing
the amount available for program grants to $2.7 billion. In order to
maintain the program's purchasing power, States would have no choice
but to reduce the number of households served from about 6.7 million to
5.3 million, or about 15 percent of eligible households.
Fiscal year 2015 Funding Request and fiscal year 2016 Advanced Funding
Request
For fiscal year 2015 we are requesting that the Subcommittee
restore funding for LIHEAP to the authorized level of $5.1 billion. The
additional funds would allow States to increase the number of
households served to 8.1 million, raise the average grant to at least
50 percent of the cost of home heating, and expand the number of
households served by home cooling.
In addition, we are concerned that States will be hampered in their
ability to administer their programs efficiently due to the lack of
advanced funding. The lack of a final program appropriation prior to
the beginning of the fiscal year creates significant administrative
problems for States in setting their program eligibility guidelines. To
address this concern, we are requesting advance appropriations of $5.1
billion for fiscal year 2016.
What Is the Impact of Declining Federal Funds?
Surveys of families receiving Federal assistance have been
consistent over the years. Poor families struggle to pay their home
energy bills. When they fall behind, they risk shut-off of energy
services or they are not able to afford the purchase of delivered
fuels. In fiscal year 2011, NEADA conducted a survey of approximately
1,800 households that received LIHEAP benefits. The results show that
LIHEAP households are among the most vulnerable in the country:
--40 percent had someone age 60 or older.
--72 percent had a family member with a serious medical condition.
--26 percent used medical equipment that requires electricity.
--37 percent went without medical or dental care.
--34 percent did not fill a prescription or took less than their full
dose of prescribed medication.
--19 percent became sick because the home was too cold.
--85 percent of people with a medical condition were seniors.
Many LIHEAP recipients were unable to pay their energy bills:
--49 percent skipped paying or paid less than their entire home
energy bill.
--37 percent received a notice or threat to disconnect or discontinue
their electricity or home heating fuel.
--11 percent had their electric or natural gas service shut off in
the past year due to nonpayment.
--24 percent were unable to use their main source of heat in the past
year because their fuel was shut off, they could not pay for
fuel delivery, or their heating system was broken and they
could not afford to fix it.
--17 percent were unable to use their air conditioner in the past
year because their electricity was shut off or their air
conditioner was broken and they could not afford to fix it.
LIHEAP's impact in many cases goes beyond providing bill payment
assistance by playing a crucial role in maintaining family stability.
It enables elderly citizens to live independently and ensures that
young children have safe, warm homes to live in. Although the
circumstances that lead each client to seek LIHEAP assistance are
different, LIHEAP links these stories by enabling people to cope with
difficult circumstances with dignity.
The Need for LIHEAP
Households reported enormous challenges despite the fact that they
received LIHEAP assistance. However, they reported that LIHEAP was
extremely important. About 64 percent reported that they would have
kept their home at unsafe or unhealthy temperatures and/or had their
electricity or home heating fuel discontinued if it had not been for
LIHEAP. Almost 98 percent said that LIHEAP was very or somewhat
important in helping them to meet their needs. In addition, 53 percent
of those who did not have their electricity or home heating fuel
discontinued said that they would have if it had not been for LIHEAP.
The members of NEADA recognize the difficult budget decisions that
you face as you consider funding levels for LIHEAP for fiscal year 2015
and advance funding for fiscal year 2016. We appreciate your interest
and continued support for LIHEAP. Please feel free to call upon us if
we can provide you with additional information.
[This statement was submitted by Mark Wolfe, Executive Director,
National Energy Assistance Directors' Association.]
______
Prepared Statement of the National Family Planning & Reproductive
Health Association
Summary: Requesting $337 million in funding for fiscal year 2015
for the national family planning program (Title X of the Public Health
Service Act).
My name is Clare Coleman; I'm the President & CEO of the National
Family Planning & Reproductive Health Association (NFPRHA), a
membership organization representing the Nation's safety-net family
planning providers--nurse practitioners, nurses, physicians,
administrators and other key healthcare professionals. Many of NFPRHA's
members receive Federal funding from Medicaid and through Title X of
the Federal Public Health Service Act, the only federally funded,
dedicated, family planning program for the low income and uninsured.
These critical components of the Nation's public health safety net are
essential resources for those providing access to high-quality services
in communities across the country. As the Committees work on the fiscal
year 2015 appropriations bill, NFPRHA respectfully requests that you
make a significant investment in Title X by including $337 million to
restore the capacity of the program to serve those in need.
NFPRHA was disappointed to see the president's fiscal year 2015
proposal only included $286.5 million for Title X. As more individuals
gain access to healthcare coverage through the Affordable Care Act, the
publicly funded family planning network will continue to play an
essential role in our Nation's service delivery framework, setting the
standard for and providing high-quality care to all patients--the
insured, uninsured, under-insured as well as patients seeking
confidential services. If the Massachusetts health reform experience
were to prove representative of what could be expected by nationwide
health reform, there will be a strong increase in demand for services
within the already-strained safety net. At present, six in ten women
describe family planning centers as their usual source of medical care.
According to a report by the Centers for Disease Control and Prevention
(CDC), as health reform in Massachusetts expanded coverage for most
people living in the State, Title X family planning health centers
continued to have high volumes of patients, both insured and uninsured,
and remained providers of choice for many.
The failure of States to expand Medicaid eligibility for all adults
up to 138 percent of the Federal poverty level (an income of $16,105 a
year for an individual in 2014)--along with new barriers to coverage
being sought by some expansion States, such as premiums and other cost-
sharing requirements--compounds the demand being placed on the Title X
safety net. Currently, 25 States have not expanded their Medicaid
eligibility under the ACA. Twenty-one of these States have Medicaid
eligibility equal to or less than 75 percent of FPL (an income of
$8,753 a year); 14 have eligibility at or below 50 percent (an income
of $5,835 a year). Five States have eligibility set at less than 25
percent of FPL--that means individuals making more than $2,918 are too
``rich'' for Medicaid.
Similar to other publicly funded health programs, Title X has
unfortunately suffered budget cuts despite rising patient need. Between
fiscal year 2010-fiscal year 2013, the Title X family planning program
was cut $39.2 million (-12.3 percent). As a result, the total number of
Title X users shrunk from 5.22 million users to 4.76 million during
this time period, with no indication that patients went elsewhere for
care. Congress made incremental progress in fiscal year 2014, funding
Title X at $286.5 million, a restoration of $8.2 million over the
fiscal year 2013 post-sequester level. As appropriators grapple with
how best to distribute limited Federal resources, NFPRHA encourages the
Committees continue to prioritize investments in programs, including
Title X, that are proven to save critical taxpayer dollars. Every $1
invested in publicly funded family planning services saves $5.68 in
Medicaid costs associated with unplanned births. Additionally, services
provided in Title X-supported centers alone yielded $5.3 billion of the
$10.5 billion in total savings for publicly funded family planning in
2010.
Lastly, Title X supports critical infrastructure and technology
necessary for modern service delivery that are not reimbursable under
Medicaid and commercial insurance. Resources for electronic health
record implementation for safety-net providers--just as for others in
the safety net--are necessary to help achieve the ACA goal of having a
nationwide health information technology infrastructure and more
coordinated models of care. Increased Title X funding is essential to
help address the gap caused by the oversight in Federal planning that
led to most family planning health providers' ineligibility for the
electronic health records (EHR) incentives available under the HITECH
Act.
For these reasons, NFPRHA urges the Committees to make a
significant investment in the Nation's safety-net family planning
health services and requests funding for Title X at $337 million in
fiscal year 2015.
[This statement was submitted by Clare Coleman, President & CEO,
National Family Planning & Reproductive Health Association.]
______
Prepared Statement of the National Head Start Association
Chairman Harkin, Ranking Member Moran, and Members of the
Subcommittee, thank you for allowing the National Head Start
Association (NHSA) to submit testimony on behalf of funding for Head
Start and Early Head Start in fiscal year 2015 . For almost 50 years,
Head Start centers have been creating opportunities for at-risk
children and families to achieve success in life by providing critical
early education, health, nutrition, parent engagement and family
support services. NHSA respectfully urges the Subcommittee to continue
its enduring bipartisan support by allocating $8,868,389,000 for Head
Start and Early Head Start in fiscal year 2015, in line with the
President's Budget.
Head Start and Early Head Start directors remain appreciative of
your leadership in ensuring that the fiscal year 2014 Omnibus
Appropriations legislation not only restored the damaging cuts from
sequestration, but also prioritized high quality by including
additional funds to retain qualified staff and cope with the increased
costs of program operation. We also sincerely appreciate the new
investment in one of our most underserved populations--low-income
infants and toddlers.
Within the total amount of funding for fiscal year 2015, we urge
the Subcommittee to continue and build on these investments. In
particular, we propose a $150 million increase to support workforce
quality improvements and to help offset the continued rise in energy,
transportation, and other fixed costs related to operating a Head Start
program. It is well known that one of the hallmarks of excellence in
any early learning program is the caliber of its teachers. Head Start
teachers are required to possess Bachelor's degrees in early learning
or related fields, which enables the program to have one of the best-
trained workforces in the country. However, the average salary for
these degreed teachers is $30,086--lower than what many schools pay
teachers, and much lower than salaries for many other jobs with
comparable education requirements.
Examples of programs losing their best staff to higher paying
schools or other providers are plentiful across the country. In New
York, one Head Start social/emotional education mentor-coach reported
seeing several ``gifted teachers, assistants and aides leave our
classrooms after short stays due to the pressure to provide for their
own families.'' Many of the staff who choose to stay with Head Start
struggle to make ends meet--such as the Oregon teachers who have
depended on a local food bank to help feed their own children. Others
depend on other income supports. Focusing increased investment toward
workforce quality improvements will help enable programs to hold on to
dedicated teachers, and provide a solid foundation for the good of our
students and families.
Supporting a High-Quality Birth-to-Five Pipeline:
NHSA also urges the Subcommittee to support the continued
development of a birth-to-five pipeline of services through expanded
access to Early Head Start, which today is only able to serve a scant 4
percent of eligible infants and toddlers. Continued early brain
research tells us that with the achievement gap present as early as 18
months, these first 2 years of life represent a critical window in
development. Early Head Start centers are among the highest quality
environments for children of this age. We propose that the Subcommittee
continue to fund the new Early Head Start-Child Care Partnerships at
$500 million. These funds should, as in fiscal year 2014, support the
straight expansion of Early Head Start as well as partnerships with
Child Care providers, ensuring programs designed by and solely based on
the needs of individual communities.
We are aware of many underserved areas with few options for
partnerships--these communities should be given as much flexibility as
possible to increase access to high-quality care. For example, Audubon
Area Community Services, Inc. in Kentucky serves a 16 county area.
However, even though there are an estimated 17,911 children in their
service area that are eligible for Early Head Start, they are only
funded to serve 301 Early Head Start slots. In two of those 16
counties, there are 600 eligible children but no licensed child care
facilities with which possibly to partner. In yet a third county, there
is licensed child care but none of it for infants and toddlers. With
flexibility to invest in expansion, they could find a way to serve
those areas.
Further, NHSA also urges the Subcommittee to allocate $100 million
to fund the expansion of the Birth-to-Five pilot programs that the
Office of Head Start (OHS) began last year in Detroit, Baltimore,
Jersey City, Washington, DC, and Mississippi's Sunflower County as part
of the first Designation Renewal System (DRS) recompetition. The grants
are meant to encourage applicants to develop comprehensive, flexible,
seamless Birth-to-Five programs which incorporate both Head Start and
Early Head Start funding. We hope the Subcommittee will recognize the
value of this approach and support expansion of these models outside of
DRS. In particular, we suggest that the Administration utilize a
portion of the funds to create a process that enables current grantees
that hold both types of grants to streamline the administrative burden
and combine these two grants into one.
These Birth-to-Five expansion funds should also be used to assist
Head Start grantees to add Early Head Start slots and convert existing
Head Start slots for 3-4 year olds to Early Head Start slots; both
actions support the goal of providing an Early Head Start slot to
complement each Head Start slot. Across the country, as States and
localities both expand and contract services for infants, toddlers, and
preschoolers, Head Start programs have the necessary skills to adapt
their services to fit the changing needs of their community. But as
resources shift, additional funding to help transition to new or
different types of slots would be a welcome support.
For instance, many States have increased their investment in
serving 4-year-olds in a variety of settings through their mixed
delivery system, including through organizations who receive Head Start
grants. Head Start grantees are able to tap into this funding stream to
support and expand their current services to 4-year-olds--however many
of those communities are now under-investing in low-income infants and
toddlers. If that same Head Start grantee were able to apply for funds
to help transition some of its Head Start slots to Early Head Start
slots, the community would then be served by a more comprehensive
birth-to-five pipeline--meeting a significant need for the working
parents of very young children.
Ongoing Quality Improvements:
Robust funding for Head Start and Early Head Start will ensure that
key quality improvement initiatives are able to continue at the Office
of Head Start. In particular, we are keen for the Office of Head Start
to finalize an update to our rigorous performance standards as mandated
in the 2007 Head Start Reauthorization Act. Serious and meaningful
efforts are underway to ensure that the standards are modernized to
reflect the needs of today's children, families, teachers, staff, and
communities--while allowing for innovation and local adaptability.
These standards are the heart of Head Start's model, and critical to
future success.
Further, we are hopeful that the Office of Head Start is able to
continue its improvements to the Head Start Monitoring System--the
oversight mechanism that ensures Head Start and Early Head Start
grantees are meeting all of their high standards. We are pleased that
the Office has instituted new initiatives that aim to work with
programs to prevent issues before they occur. We are also appreciative
that they are enabling iterative feedback and data collection to better
target assistance and intervention where programs require it most.
These are welcome changes, and we are hopeful that the Office of Head
Start is afforded the resources to continue these improvements.
One of the best-known provisions of the 2007 Head Start Act
requires Head Start grantees designated as low-performing to compete
for the continuation of their grant. Different from the Head Start
grant termination process, this additional accountability measure, the
Designation Renewal System (DRS) which is now in its third cycle, has
been an enormous undertaking for the Office of Head Start and requires
adequate resources to fully staff and execute.
We support the Administration's request for $25 million to assist
with grantee transition costs in the event that a grant turns over,
though NHSA remains concerned that the Office of Head Start's timetable
for executing these competitions is unintentionally poorly timed.
Currently, Head Start grantees are notified in January of their
recompetition status, but the results of those competitions are not
determined until late in the summer. With a school year beginning
shortly thereafter, any new grantee taking over for a low-quality
incumbent faces a steep climb to recruit teachers, enroll children, and
find any necessary facilities and other resources to start up their
program. This is an avoidable strain on communities.
Considering the opportunity that DRS provides to improve program
quality, we must ensure that the process is done right. We hope the
Subcommittee considers additional assistance to the Office of Head
Start to ensure that these competitions are run effectively and
efficiently, and that the process is accurately capturing programs that
are of low quality.
Head Start is a High Yield Investment:
To take a step back, NHSA believes that the budget caps now in
place limit the opportunities to make effective investments in our
future. President Obama proposed an additional $800 million to support
Head Start and Early Head Start expansion. We support the President's
focus on the need to reach the large population of underserved, at-risk
infants, toddlers, and preschoolers, but understand that appropriations
that exceed the fiscal year 15 budget caps are unlikely.
Certainly, we respect the idea that our debt cannot be left for the
very children we serve. We do hope that deficit reduction can still be
achieved in a way that does not squander our highest-yield investments.
Studies show that for every one dollar invested in a Head Start child,
society earns at least $7 back through increased earnings, employment,
and family stability; \1\ as well as decreased welfare dependency,\2\
healthcare costs,\3\ crime costs,\4\ grade retention,\5\ and special
education.\6\ These are the very results taxpayers demand.
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\1\ Ludwig, J. and Phillips, D. (2007). The Benefits and Costs of
Head Start. Social Policy Report. 21 (3: 4); Deming, D. (2009). Early
childhood intervention and life-cycle skill development: Evidence from
Head Start. American Economic Journal: Applied Economics, 1(3): 111-
134; Meier, J. (2003, June 20). Interim Report. Kindergarten Readiness
Study: Head Start Success. Preschool Service Department, San Bernardino
County, California; Deming, D. (2009, July). Early childhood
intervention and life-cycle skill development: Evidence from Head
Start, p. 112.
\2\ Meier, J. (2003, June 20). Kindergarten Readiness Study: Head
Start Success. Interim Report. Preschool Services Department of San
Bernardino County.
\3\ Frisvold, D. (2006, February). Head Start participation and
childhood obesity. Vanderbilt University Working Paper No. 06-WG01;
Currie, J. and Thomas, D. (1995, June). Does Head Start Make a
Difference? The American Economic Review, 85 (3): 360; Anderson, K.H.,
Foster, J.E., & Frisvold, D.E. (2009). Investing in health: The long-
term impact of Head Start on smoking. Economic Inquiry, 48 (3), 587-
602.
\4\ Reuters. (2009, March). Cost of locking up Americans too high:
Pew study; Garces, E., Thomas, D. and Currie, J. (2002, September).
Longer-term effects of Head Start. American Economic Review, 92 (4):
999-1012.
\5\ Barnett, W. (2002, September 13). The Battle Over Head Start:
What the Research Shows.; Garces, E., Thomas, D. and Currie, J. (2002,
September). Longer-Term Effects of Head Start. American Economic
Review, 92 (4): 999-1012.
\6\ NHSA Public Policy and Research Department analysis of data
from a Montgomery County Public Schools evaluation. See Zhao, H. &
Modarresi, S. (2010, April). Evaluating lasting effects of full-day
prekindergarten program on school readiness, academic performance, and
special education services. Office of Shared Accountability, Montgomery
County Public Schools.
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Again, the Head Start community understands the pressure the
Subcommittee faces and is grateful for the commitment shown by Congress
and the President to keep early learning, and Head Start in particular,
as a priority. We urge the Subcommittee to build on the investments
made in Head Start and Early Head Start, to increase access, to improve
accountability, and ensure the prosperity of our next generation. Thank
you for your time and consideration.
[This statement was submitted by Yasmina Vinci, Executive Director,
National Head Start Association.]
______
Prepared Statement of the National Indian Child Welfare Association
The National Indian Child Welfare Association (NICWA) is a national
American Indian/Alaska Native (AI/AN) nonprofit organization. NICWA has
over 35 years of experience providing leadership in the development of
public policy that supports tribal self-determination in child welfare
and children's mental health systems.
Child Welfare Overview
Tribes have an important relationship with their children and
families: they are experts in the needs of AI/AN children, best suited
to effectively serve those needs, and most able to improve child
welfare outcomes for these children (NICWA & Pew Charitable Trust,
2007). In addition, statistics show that AI/AN children face elevated
rates of child abuse and neglect (Dept. of Health and Human Services,
2012). The key to successful tribal child welfare is a budget that
avoids unnecessary restraint on tribal decisionmaking and accounts for
the elevated need. For this reason we make the following
recommendations:
--For programs administered by the Department of Health and Human
Services, Administration for Children and Families: Promoting
Safe and Stable Families ($75 million discretionary; $345
million mandatory), Child Welfare Services ($280 million),
Child Abuse Discretionary Activities ($35 million), Community
Based Child Abuse Prevention Program ($60 million), and
Demonstration to Address Over-Utilization of Psychotropic
Medications for Children in Foster Care ($250 million).
Children's Mental Health Overview
To understand the mental health needs of AI/AN children,
policymakers must consider the legacy of trauma that has been visited
upon this population and left them with unresolved historical trauma
(Yellow Horse Brave Heart and DeBruyn, 1998). Inadequate funding,
uncoordinated health systems, cultural incompetence, and a shortage of
mental health professionals are barriers to the development of
successful mental health systems of care in AI/AN communities (Novins &
Bess, 2011). Key to children's mental health programs in tribal
communities is a budget that supports and strengthens a system of
tribally driven children's mental health prevention, intervention, and
treatment. For this reason we make the following recommendations:
--For programs administered by the Department of Health and Human
Services, Substance Abuse Mental Health Services
Administration: Programs of Regional and National Significance,
Children and Family Programs ($6.5 million), Children's Mental
Health Services Program, Children's Mental Health Initiative
($117 million), Tribal Behavioral Health Grants ($40 million),
GLS Youth Suicide Prevention Program ($35.5 million), and AI/AN
Suicide Prevention ($2.94 million).
child welfare priority recommendations
Child Welfare Services Program recommendation: Restore funding to
at least $280 million, to increase funding for tribal programs while
still providing for an increase in state funding.
This program provides funds to promote program flexibility and fill
gaps in child welfare programming. Tribes receive an allocation based
on a population-based formula identified within the regulations. This
tribal allocation is then deducted from the state's allocation. Studies
show that culturally competent programs, resources, and case management
result in better outcomes for AI/AN children and families involved in
the child welfare system (Red Horse, Martinez & Day, 2001). The funding
of the Child Welfare Service Program is flexible enough for tribes to
tailor their child welfare services to fit their communities' needs and
culture.
Without adequate funding AI/AN children and families in tribal
communities cannot receive the care they need and remain at risk of
further harm and trauma. Of the 566 federally recognized tribes 180
depend on this funding. The median tribal grant is about $13,300 an
insufficient amount to support all the gaps in tribal services this
program can fill. Because of the way the formula for tribal grants has
been created, it is essential to increase the entire appropriation of
this program to $280 million to increase tribal amounts.
Promoting Safe and Stable Families recommendation: Increase
discretionary funding to $75 million to allow more tribes, who are
currently ineligible, access to these funds. As recommended by the
President's Budget fully fund the $345 million in mandatory funding cut
due to sequestration.
PROMOTING SAFE AND STABLE FAMILIES (SOCIAL SECURITY ACT TITLE IV-B, SUBPART 2)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fiscal year
Fiscal year Fiscal year Fiscal year 2015 Fiscal year
2012 enacted 2013 * 2014 enacted president 2015 Authorization
enacted budget recommended
--------------------------------------------------------------------------------------------------------------------------------------------------------
Mandatory.......................................................... $345,000,000 $327,405,500 $320,160,000 $345,000,000 $345,000,000 $345,000,000
Discretionary...................................................... 63,065,000 59,671,500 59,765,000 59,765,000 75,000,000 200,000,000
Total.............................................................. 408,065,000 387,077,000 379,925,000 404,765,000 420,000,000 545,000,000
Tribal Mandatory................................................... 9,149,000 8,459,200 9,604,800 10,350,000 14,100,000 3% set aside
Tribal Discretionary............................................... 1,892,000 1,790,000 1,792,950 1,792,950 2,250,000 of total
Tribal Total....................................................... 11,041,000 10,249,200 11,397,750 12,142,950 16,350,000 appropriation
--------------------------------------------------------------------------------------------------------------------------------------------------------
* Reflects sequestration effects.
This program is designed to provide funds to operate a coordinated
program of family preservation, family support, reunification, and
adoption services. Promoting Safe and Stable Families is authorized
with both a mandatory capped entitlement ($345 million) as well as a
discretionary appropriation ($200 million). Tribes are eligible for
funds based on a 3 percent set-aside of the total appropriation. All
tribes whose plan receives approval are eligible for a portion equal to
that tribe's relative share of children compared with all tribal
entities with approved plans. Tribes who would qualify for less than 10
thousand dollars under the formula are not eligible to receive funding.
Tribal child welfare programs work tirelessly to strengthen
families and provide services that keep children safely in their homes.
This program is an integral part of these efforts. It supports
parenting classes, home-visiting services, respite care for caregivers
of children, and other services that safely preserve families.
One hundred and thirty tribes and tribal consortia depend on this
funding. Yet because of the funding levels, many tribes are ineligible
for these formula grant dollars as their portion of the tribal set-
aside is less than $10,000. Increasing this program's discretionary
funding to $75 million and fully funding the $345 million in mandatory
funding would help dozens of new tribes access this funding and
hundreds of families obtain tribal child welfare services.
child welfare other recommendations
Child Abuse Discretionary Activities, including Innovative
Evidence-Based Community Prevention Programs recommendation: Increase
appropriations to $35 million to account for tribes' recent eligibility
for these funds while holding state and other grantees harmless.
The Community Based Child Abuse Prevention Program recommendation:
Increase funding to $60 million, so that more tribes can have access to
these scarce child abuse prevention dollars.
Demonstration to Address Over-Utilization of Psychotropic
Medications for Children in Foster Care (Presidents fiscal year 2015
Initiative) recommendation: Fund this initiative at the proposed $250
million and ensure a tribal set-aside of 3 percent so that tribal
communities can also participate in this important initiative to ensure
children receive holistic mental healthcare.
department of health and human services recommendations substance abuse
and mental health services administration
children's mental health priority recommendations
Programs of Regional and National Significance: Children and Family
Programs (Circles of Care) recommendation: Fund Circles of Care Program
at $6.5 million as recommended by the President to ensure current
communities can continue their important work and new tribal
communities can have access to this program.
The Children and Family Programs line item represents funds
allocated to the Circles of Care Program. The Circles of Care program
is the cornerstone of children's mental health programming in tribal
communities. The Circles of Care program is the only SAMHSA grant
program that is focused specifically on AI/AN children's mental health
needs. It is also the only SAHMSA program that allows tribes and tribal
organizations to apply without competing for funding with other
governmental entities such as States, counties, or cities. There are
currently seven communities receiving Circles of Care funding.
The American Psychiatric Association has found that AI/AN children
and youth face a "disproportionate burden" of mental health issues
while simultaneously facing more barriers to quality mental healthcare
(2010). Circles of Care provides communities with funding to plan and
build culturally competent services and design integrated supports that
meet the specific needs of their youth with behavioral health
challenges. It is essential to the well-being of AI/AN children. It is
imperative that funding that matches the President's Budget request of
$6.5 million be reserved in this line item for the Circles of Care
program. This will ensure that more tribal communities can access this
grant and improve their children's mental healthcare systems.
Children's Mental Health Services Program: Children's Mental Health
Initiative (Systems of Care) recommendation: Maintain funding at $117
million to continue support of Tribal children's mental health systems
change efforts.
The various Systems of Care grants funded under this line item
support a community's efforts to plan and implement strategic
approaches to mental health services and supports that are family
driven; youth guided; strength based; culturally and linguistically
competent; and meet the intellectual, emotional, cultural, and social
needs of children and youth.
The American Psychiatric Association (APA; 2010) has recognized
family, culture, and traditional health practices as important
protective factors for AI/ANs struggling with mental health challenges.
The Systems of Care program, which foster those protective factors
described by the APA, has been both well-received and particularly
effective in tribal communities. Currently, 17 tribal communities are
funded under the Children's Mental Health Initiative line item.
The well-being of AI/AN children is dependent on the ability of
more tribes to access these funds and create real systems change. Thus,
funding must be maintained at $117 million as recommended by the
President's Budget. This will ensure the current Systems of Care
grantees can continue, and a new robust cohort of grantees can begin
this important work.
children's mental health recommendations
Tribal Behavioral Health Grants recommendation: Implement
President's Budget fiscal year 2013 recommendation to fund this new
initiative at $40 million so that additional tribal communities can
receive resources for children's mental health and substance abuse.
The GLS State/Tribal Youth Suicide Prevention and Early
Intervention Program recommendation: Keep funding at the fiscal year
2014 appropriated level of $35.5 million to ensure that current
grantees can complete their projects, and a similar sized cohort of
annual grantees will have access to this program.
AI/AN Suicide Prevention program recommendation: Fund at the
President's Budget recommended amount of $2.94 million, to ensure that
the epidemic of AI/AN suicide receives the attention it warrants.
If you have any questions about this testimony please contact NICWA
Government Affairs Associate Addie Smith at addie@nicwa.org.
______
Prepared Statement of the National Indian Education Association
The National Indian Education Association (NIEA) was incorporated
in 1970 and is the most representative Native education organization in
the United States. NIEA's mission is to advance comprehensive and equal
educational opportunities for American Indian, Alaska Native, and
Native Hawaiian students. NIEA supports tribal sovereignty over
education as well as strengthening traditional Native cultures and
values that enable Native learners to become contributing members of
their communities. As the most inclusive Native education organization,
NIEA membership consists of tribal leaders, educators, students,
researchers, and education stakeholders from all 50 States. From
communities in Hawaii, to tribal reservations across the continental
U.S., to villages in Alaska and urban communities in major cities, NIEA
has the most reach of any Native education organization in the country.
Tribes and Native communities have a tremendous stake in an
improved education system, because an improved system equates to better
services for Native people and students. As tribes work to increase
their footprint in education, there must be support for that increased
participation. The Federal Government must uphold its trust
relationship with tribes. Established through treaties, Federal law,
and U.S. Supreme Court decisions, this relationship includes a
fiduciary obligation to provide parity in access and equal resources to
all American Indian and Alaska Native students, regardless of where
they attend school. National fiscal and policy concerns should not be
addressed by decreasing funds and investment to Native students or the
programs that serve them. Rather, Native education, including those
programs and services under the Departments of Education (ED) and
Health and Human Services (HHS), is one of the most effective and
efficient investments the Federal Government can make.
As tribes and Native communities work with Congress for parity in
access to increase their role and responsibility in administering
education, Federal support for tribal governments and Native education
institutions has continued to shrink as a percentage of the Federal
budget. Historical funding trends illustrate that the Federal
Government is abandoning its trust responsibility by decreasing Federal
funds to Native-serving programs by more than half in the last 30
years. Sequestration only exacerbated those shortfalls.
While fiscal year 2014 funding increases over sequestration levels
were welcome, several Native-serving programs remained flat with 2013
sequestration levels, such as Elementary and Secondary Education Act
Title VII funding. These levels continue to be insufficient for
effectively and equally serving Native students. Partly as a result of
this insufficient funding, Native students continue to lag behind their
non-Native peers. Graduation rates often hover around 50 percent in
many States, which can lead to increased substance abuse, criminal
acts, and extended periods of unemployment. If the 25,000 Native
students who dropped out of the Class of 2010 had graduated, an
additional $295 million would likely have been added to total annual
earnings, supplementing local and regional economies.
To provide tribes and Native communities the educational
institutions that supplement economic growth, the Federal Government
should fund Native education programs at the levels requested below as
they detail the minimum appropriations needed to maintain a system that
is already struggling and underfunded. The following funding requests
illustrate continuing need for Native programs but do not comprise the
full list of budget requests, which can be found in the fiscal year
2015 NIEA Budget Document. Further, NIEA supports the budget requests
of the National Congress of American Indians and American Indian Higher
Education Consortium.
State-Tribal Education Partnership (STEP) Program (ED)
--Provide $5 million. An increase of $3 million.
Congress appropriated roughly $2 million dollars for the STEP
program to five participating tribes under the Tribal Education
Department appropriations. In order for this program to successfully
achieve the original intent of the appropriation, it must receive its
own line and authorization of appropriations in fiscal year 2015.
Collaboration between tribal education agencies and State education
agencies is crucial to developing the tribal capacity to assume the
roles, responsibilities, and accountability of tribal education
departments that increase self-governance in Native education.
Impact Aid (ED)
--Provide $2 billion for Impact Aid, under ESEA Title VIII. An
increase of $711 million.
Impact Aid provides direct payments to public school districts as
reimbursement for the loss of traditional property taxes due to a
Federal presence or activity, including the existence of an Indian
reservation. With nearly 93 percent of Native students enrolled in
public schools, Native students were disproportionately affected by the
devastating reductions implemented under sequestration. Additional
funds are required to cover previous Impact Aid shortfalls.
Title VII (Indian Education Formula Grants in ED)
--Provide $198 million under ESEA Title VII, Part A. An increase of
$74 million.
This grant funding is designed to supplement the regular school
program and assist Native students so they have the opportunity to
achieve the same educational standards as their non-Native peers. Title
VII funding, which was maintained at 2013 sequestration levels in
fiscal year 2014, only reaches 500,000 Native students leaving over
100,000 without supplementary academic and cultural programs in their
schools. As Native students continually lag behind their non-Native
peers in educational achievement, increased funding is necessary to
address this substantial gap.
Native Hawaiian Education Program (ED)
--Provide $35 million under ESEA Title VII, Part B. An increase of $3
million.
The Native Hawaiian Education program empowers innovative
culturally-appropriate programs to enhance the quality of education for
Native Hawaiians. When establishing the Native Hawaiian Education
Program, Congress acknowledged the trust relationship between the
Native Hawaiian people and the United States. These programs strengthen
Native Hawaiian culture and improve educational attainment, both of
which are correlated with positive economic outcomes.
Alaska Native Education Equity Assistance Program (ED)
--Provide $35 million under ESEA Title VII, Part C. An increase of $5
million.
This assistance program funds the development of curricula and
education programs that address the unique educational needs of Alaska
Native students as well as the development and operation of student
enrichment programs in science and mathematics. Other eligible
activities include professional development for educators, activities
carried out through Even Start and Head Start programs, family literacy
services, and dropout prevention programs.
Vocational Rehabilitation Services Projects for American Indians with
Disabilities (ED)
--Provide $67 million to Vocational Rehabilitation Services Projects.
Create a line item of $5 million for providing outreach to
tribal recipients.
According to the Centers for Disease Control and Prevention,
approximately 30 percent of Native adults have a disability--the
highest rate of any other population in the Nation. Of those, 51
percent reported having fair or poor health. A number of issues
contribute to this troubling reality, including high incidences of
diabetes, heart disease, and preventable accidents. As a result, tribes
have an extraordinary need to support their disabled citizens in
improving their health, attaining experiential learning courses, and
becoming self-sufficient. Tribes have limited access to funding for
vocational rehabilitation and job training as compared to States and
$67 million would begin to put tribes on par to support their disabled
citizens.
Native Languages Preservation (Esther Martinez Program Grants in HHS)
--Provide $12 million for Native language preservation with $5
million designated to fund the Esther Martinez Native Language
Programs. An increase of $3 million.
Native language grant programs are essential to revitalizing Native
languages and cultures, many of which are at risk of disappearing in
the upcoming decades. In addition to protecting Native languages, these
immersion programs promote higher academic success for participating
students in comparison to their Native peers who do not participate.
The Federal budget should include $12 million for Native language
preservation activities which would include $5 million designated to
support Esther Martinez Native Language Programs' immersion
initiatives.
Thank you for your consideration of this testimony. For more
information or to attain NIEA's complete budget document with all
fiscal year 2015 requests for the Departments of Education and Health
and Human Services, please contact Ahniwake Rose, NIEA Executive
Director, at arose@niea.org.
______
Prepared Statement of the National Kidney Foundation
The National Kidney Foundation (NKF) is pleased to submit testimony
for the written record in support of the Centers for Disease Control
and Prevention Chronic Kidney Disease Program, the National Institute
of Diabetes and Digestive and Kidney Disease, and the Health Resources
and Services Administration Division of Transplantation. NKF is
America's largest and oldest health organization dedicated to the
awareness, prevention and treatment of kidney disease for hundreds of
thousands of healthcare professionals, millions of patients and their
families, and tens of millions of people at risk. In addition, we have
provided universally recognized evidence-based clinical practice
guidelines for all stages of chronic kidney disease (CKD) since 1997
through the NKF Kidney Disease Outcomes Quality Initiative (NKF KDOQI).
We respectfully request fiscal year 2015 funding of $2.1 million
for the CDC Chronic Kidney Disease Program, $2.066 billion for NIDDK,
and $24 million for the HRSA Division of Transplantation.
In 2011, almost 616,000 Americans had End Stage Renal Disease
(ESRD), including more than 430,000 dialysis patients and nearly
186,000 kidney transplant recipients, with members of many minority
populations disproportionately affected. Complicating the cost and
human toll is the fact that it is a disease multiplier, with patients
very likely to be diagnosed with diabetes, cardiovascular disease, or
hypertension (40 percent of ESRD patients had a diagnosis of diabetes
and two-thirds have diabetes or hypertension). ESRD is the only
disease-specific coverage under Medicare regardless of age or other
disability. In 2011, ESRD was present in 1.4 percent of Medicare
beneficiaries but responsible for more than 7 percent of Medicare
expenditures. (1)
NKF recently announced an initiative to help address awareness of
CKD by increasing communication between practitioners and patients.
There is a misconception that once someone is diagnosed with CKD, there
must be a referral to a nephrologist. However, there are not enough
nephrologists to care for the 15 percent of the U.S. population with
chronic kidney disease. NKF's CKD Primary Care Initiative will
disseminate CKD guidelines to primary care physicians through education
programs, symposia and practical implementation tools so they can
provide this care to the growing numbers of Americans with CKD. Our
initiative will help build on CDC's program, outlined below.
CDC Chronic Kidney Disease Program
To address the social and economic impact of kidney disease, NKF
worked with Congress to initiate a Chronic Kidney Disease Program at
CDC in fiscal year 2006. Prior to this, no national public health
program focusing on early detection and treatment existed. Cost-
effective treatments exist to potentially slow progression of kidney
disease and prevent its complications, but only if individuals are
diagnosed before the latter stages of CKD.
The CDC program is designed to identify members of populations at
high risk for CKD, develop community-based approaches for improving
detection and control, and educate health professionals about best
practices for early detection and treatment. The National Kidney
Foundation respectfully urges the Committee to maintain $2.1 million in
line-item funding for the Chronic Kidney Disease Program for fiscal
year 2015. Continued support will benefit kidney patients and Americans
who are at risk for kidney disease, advance the objectives of Healthy
People 2020 and the National Strategy for Quality Improvement in Health
Care, and fulfill the mandate created by Sec. 152 of the Medicare
Improvement for Patients and Providers Act.
It is estimated that CKD affects 26 million adult Americans (2) and
73 million more are at risk. Furthermore, a task force of the American
Heart Association noted that decreased kidney function has consistently
been found to be an independent risk factor for cardiovascular disease
(CVD) outcomes and all-cause mortality and that the increased risk is
present with even mild reduction in kidney function. (3) Therefore
addressing CKD is a way to achieve one of the priorities in the
National Strategy for Quality Improvement in Health Care: Promoting the
Most Effective Prevention and Treatment of the Leading Causes of
Mortality, Starting with Cardiovascular Disease.
CKD is often asymptomatic, especially in the early stages and
therefore goes undetected without laboratory testing. Some people
remain undiagnosed until they have reached CKD Stage 5 and must begin
dialysis immediately. However, early identification and treatment can
slow the progression of kidney disease, delay complications, and
prevent or delay kidney failure. Accordingly, Healthy People 2020
Objective CKD--2 is to ``increase the proportion of persons with
chronic kidney disease (CKD) who know they have impaired renal
function.''
Screening and early detection provides the opportunity for
interventions to foster awareness, foster adherence to medications and
control risk factors. Additional data collection is required to
precisely define the incremental benefits of early detection on kidney
failure, cardiovascular events, hospitalization and mortality.
Increasing the proportion of persons with CKD who know they are
affected requires expanded public and professional education programs
and screening initiatives targeted at populations who are at high risk.
As a result of consistent congressional support, the National Center
for Chronic Disease Prevention and Health Promotion at CDC has
instituted a series of projects that could assist in attaining the
Healthy People 2020 objective. However, this forward momentum will be
stifled and CDC's investment in CKD to date jeopardized if line-item
funding is not continued.
As noted in CDC's Preventing Chronic Disease: April 2006, Chronic
Kidney Disease meets the criteria to be considered a public health
issue: (1) the condition places a large burden on society; (2) the
burden is distributed unfairly among the overall population; (3)
evidence exists that preventive strategies that target economic,
political, and environmental factors could reduce the burden; and (4)
evidence shows such preventive strategies are not yet in place.
The Chronic Kidney Disease program has consisted of three projects
to promote kidney health by identifying and controlling risk factors,
raising awareness, and promoting early diagnosis and improved outcomes
and quality of life for those living with CKD. These projects include
(1) demonstrating approaches for identifying individuals at high risk
for CKD through State-based screening; (2) conducting an economic
analysis on the economic burden of CKD and the cost-effectiveness of
interventions; and (3) establishing a surveillance system for CKD by
analyzing and interpreting information to assist in prevention and
health promotion efforts for kidney disease. The surveillance project
includes a CDC website program containing information on risk factors,
early diagnosis, and strategies to improve outcomes.
Undetected Chronic Kidney Disease can lead to costly and
debilitating irreversible kidney failure. However, cost-effective
interventions are available if patients are identified in the early
stages of CKD. With the continued support of Congress, NKF is confident
a feasible detection, surveillance and treatment program can be
established to slow, and possibly prevent, the progression of kidney
disease.
NIDDK
NKF joins multiple other kidney patient and professional
organizations to request $2.066 billion for NIDDK in fiscal year 2015.
Medicare spends $77 billion annually to care for patients with kidney
disease, including nearly $35 billion for individuals with ESRD, yet
NIH funding for kidney disease research is only about $600 million
annually or less than $25 per patient for the 26 million adults with
CKD. In March 2014, NKF hosted a Kidney Patient Summit that included
participation from our advocates and those of five other kidney patient
organizations. Increased Federal support for kidney disease research
was one of the requests the advocates presented in meetings with their
congressional delegations.
We were honored to have NIDDK Director Dr. Griffin Rodgers address
the Kidney Summit where we learned of exciting opportunities in CKD
research. America's scientists are at the cusp of many potential
breakthroughs in improving our understanding of CKD and providing new
therapies to delay and treat various kidney diseases. With the unique
status of ESRD in the Medicare program, it can be argued that
breakthroughs in CKD have the potential to provide cost savings to the
Federal Government like that of no other chronic disease. We urge
Congress to continue its strong bipartisan support for NIH in fiscal
year 2015 and to fund NIDDK at this requested level that is widely
supported by the kidney community.
HRSA Organ Transplantation
NKF also urges the Committee to support the President's Budget
Request of $24 million for organ donation and transplantation programs
run by the Health Resources and Services Administration's (HRSA)
Division of Transplantation (DoT). This represents an increase of less
than $500,000 over the fiscal year 2014 level and would restore funding
to the fiscal year 2012 level.
The national organ transplant wait list contains more than 122,000
listings, including 100,000 people waiting for a kidney.
Transplantation remains the treatment of choice for most patients with
kidney failure yet few of them will be given an opportunity to receive
a new kidney, especially if they do not have a potential living kidney
donor. Kidney recipients often have an improved quality of life (and
are more likely to stay in or return to the work force) and
transplantation is tremendously cost effective. Medicare spends about
$25,000 per year on a kidney recipient after the year of transplant,
compared to more than $80,000 annually on a dialysis patient (these
figures reflect all Medicare expenses and are not limited to kidney
related care).
The HRSA program supports the Organ Procurement and Transplantation
Network (OPTN) which allocates donor organs to individuals on wait
lists. Additional activities supported by DoT include initiatives to
increase the number of donor organs; a grant program to assist living
donors with out-of-pocket expenses that are not reimbursed by
insurance, a health benefit program, or any other State or Federal
program; State donor registry initiatives to enroll potential donors;
and, activities to build upon achievements of HRSA's Breakthrough
Collaboratives of a decade ago.
Thank you for your consideration of our requests for fiscal year
2015.
(1) 2013 U.S. Renal Data System Annual Report.
(2) Josef Coresh, et al. ``Prevalence of Chronic Kidney Disease in
the United States,''JAMA, November 7, 2007.
(3) Mark J. Sarnak, et al. Kidney Disease as a Risk Factor for the
Development of Cardiovascular Disease: A Statement from the American
Heart Association Councils on Kidney in Cardiovascular Disease, High
Blood Pressure Research, Clinical Cardiology, and Epidemiology and
Prevention. Circulation 2003: 108: 2154-69.
______
Prepared Statement of the National League for Nursing
The National League for Nursing (NLN) is the premiere organization
dedicated to promoting excellence in nursing education to build a
strong and diverse nursing workforce to advance the Nation's health.
With leaders in nursing education and nurse faculty across all types of
nursing programs in the United States--doctorate, master's,
baccalaureate, associate degree, diploma, and licensed practical--the
NLN has more than 1,200 nursing school and healthcare agency members,
40,000 individual members, and 24 regional constituent leagues.
The NLN urges the subcommittee to fund the following HRSA nursing
programs:
--The Title VIII Nursing Workforce Development Programs at $251
million in fiscal year 2015; and
--The Title III Nurse-Managed Health Clinics at $20 million in fiscal
year 2015.
Nursing Education Is a Jobs Program
According to the Bureau of Labor Statistics (BLS), the registered
nurse (RN) workforce will grow by 19.4 percent from 2012 to 2022,
outpacing the 11 percent average for most occupations. BLS projects
that this growth will result in 1,052,600 job openings in the economy,
representing one of the largest numeric job increases for all
occupations. BLS calculates the openings from an increase of 526,800
new RN jobs due to technological advancements fueling growth in
treatments, preventive care being emphasized more, expanding demand
from new health reform enrollments, and accelerating demand from the
two million Baby Boomers aging into Medicare every year. A particularly
disconcerting element of the probable RN job openings is a loss of
nursing expertise owing to the replacement need of some 525,700 jobs
vacated by RNs expected to leave the profession and/or retire from the
labor force by 2022.
The March 7, 2014, BLS Employment Situation Summary--February 2014
likewise reinforces the strength of the nursing workforce in creating
job growth. While the Nation's overall unemployment rate was little
changed at 6.7 percent for February 2014, the employment in healthcare
increased with the addition of 10,000 jobs at ambulatory healthcare
services, hospitals, and nursing and residential care facilities,
amounting to an unemployment rate of only 4.0 percent in the industry.
BLS notes that the healthcare sector is a critically important
industrial complex for the Nation. It is at the center of the economic
recovery with the number of jobs climbing steadily. Growing even when
the recession began in December 2007, healthcare jobs are up
nationwide. Almost five million workers are in hospital settings, which
often are the largest employer in a State. Healthcare has been a
stimulus program generating employment and income, and nursing is the
predominant occupation in the healthcare industry with more than 4.031
million active, licensed RNs in the United States in 2014.
The Nursing Workforce Development Programs provide training for
entry-level and advanced degree nurses to improve the access to, and
quality of, healthcare in underserved areas. The Title VIII nursing
education programs are fundamental to the infrastructure delivering
quality, cost-effective healthcare. The NLN applauds the subcommittee's
bipartisan efforts to recognize that a strong nursing workforce is
essential to a health policy that provides high-value care for every
dollar invested in capacity building for a 21st century nurse
workforce.
The current Federal funding falls short of the healthcare
inequities facing our Nation. Absent consistent support, slight boosts
to Title VIII will not fulfill the expectation of generating quality
health outcomes, nor will episodic increases in funding fill the gap
generated by a 15-year nurse and nurse faculty shortage felt throughout
the U.S. health system.
The Nurse Pipeline and Education Capacity
Although the recession resulted in some stability in the short-term
for the nurse workforce, policy makers must not lose sight of the long-
term growing demand for nurses in their districts and States. The NLN's
findings from its Annual Survey of Schools of Nursing--Academic Year
2011-2012 cast a wide net on all types of nursing programs, from
diploma through doctoral, to determine rates of application,
enrollment, and graduation. This data can be found at http://
www.nln.org/researchgrants/slides/index.htm. Key findings include:
--Demand for spots in nursing education programs historically
outstripped supply. In 2012, 43 and 37 percent of master's and
doctoral nursing programs, respectively, rejected qualified
applicants. More dramatically, 72 percent of programs offering
practical nursing (PN) degrees and 84 percent offering
associate's degrees in [registered] nursing programs (ADN) were
forced to turn away qualified candidates, as did almost two-
thirds (64 percent) of baccalaureate in science of [registered]
nursing (BSN) programs. The aggregate rate across all basic RN
programs was 28 percent of qualified applications not accepted
in the Fall 2012.
--Expansion of nursing education programs impeded by shortage of
faculty. Deans and directors of schools providing programs that
did not accept all eligible applicants were asked to identify
the primary obstacle to expanding their program's capacity.
Since 2010, the percentage of those directing ADN and PN
programs that cited a shortage of clinical sites as the primary
impediment to expansion has steadily increased. For PN programs
in particular, the percentage jumped to 51 percent in 2012. By
contrast, graduate programs consistently cite a lack of faculty
as the primary obstacle to expansion. A strong correlation
exists between the shortage of nurse faculty and the inability
of nursing programs to keep pace with the demand for new nurse
faculty and new RNs. Increasing the productivity of education
programs is a high priority in most States, but faculty
recruitment is a glaring problem. Without faculty to educate
our future nurses, the shortage cannot be resolved.
--Age of associate degree students rises. A substantial increase in
the percentage of ADN students who were over 30 years old
occurred, rising in 2012 to 50 percent of the student nursing
enrollments. Because ADN students comprise two-thirds of all
pre-licensure RN enrollees, this uptick in enrollments among
older students could reignite concerns over an aging nursing
workforce and the potential for future labor shortages.
Equally Pressing Is Lack of Diversity
Our Nation is enriched by cultural diversity--37 percent of our
population identify as racial and ethnic minorities. Yet ethnic,
cultural, and gender diversity eludes the nursing student and nurse
educator populations. A survey of nurse educators conducted by the NLN
and the Carnegie Foundation's Preparation for the Professions Program
found that only 7 percent of nurse educators were minorities compared
with 16 percent of all U.S. faculty. The lack of faculty diversity
limits nursing schools' ability to deliver culturally appropriate
health professions education. In addition, the NLN survey for the 2011-
2012 academic year reported that:
--African-American enrollment drops. The percentage of racial-ethnic
minority students enrolled in pre-licensure RN programs has
declined steadily over the past 2 years--ultimately dropping
from a high of 29 percent in 2009 to 24 percent in 2011 and up
to 26 percent in 2012. The majority of that decline stems from
a steep reduction in the percentage of African-American
students enrolled in associate degree nursing programs, which
dropped by almost 5 percent to 9 percent. BSN programs saw a
small, but not significant drop, in African-American
enrollment, down from 13 to 12 percent. Inversely, diploma
programs saw a sharp rise in African-American enrollments to 30
percent, but because they represent just 4 percent of all basic
RN programs, the impact is not great.
--Hispanic representation, while still lagging, inches upward.
Hispanics remain dramatically underrepresented among nursing
students. Representing a mere 6 percent of associate degree and
baccalaureate nursing students, Hispanics were enrolled in
basic nursing programs at less than half the rate at which they
were enrolled in undergraduate programs overall. However, the
percentage of Hispanics enrolled in post-licensure programs has
nearly doubled at every level.
--Men's enrollment at historic high. While significantly less than
the proportion in the U.S. population, at 15 percent, men
enrolled in basic RN programs (i.e., 13 percent BSN, 16 percent
diploma, and 16 percent ADN) remained at the historic high
reached at the start of the recession. Approximately 11 percent
of PN students, RN-to BSN students, master's, and doctoral
students were male in 2012.
Besides representing an untapped talent pool to remedy the nursing
shortage, ethnic, cultural, and gender-diverse minorities in nursing
are essential to developing a healthcare system that understands and
addresses the needs of our rapidly diversifying population. Workforce
diversity is needed where research indicates that factors such as
societal biases and stereotyping, communication barriers, limited
cultural sensitivity and competence, and system and organizational
determinants contribute to healthcare inequities.
Title VIII Federal Funding Reality
Today's undersupply of appropriately prepared nurses and nurse
faculty, as well as the projected loss of experienced nurses over the
next decade, does not bode well for our Nation. The Title VIII Nursing
Workforce Development Programs are a comprehensive system of capacity-
building strategies that provide students and schools of nursing with
grants to strengthen education programs, including faculty recruitment
and retention efforts, facility and equipment acquisition, clinical lab
enhancements, and loans, scholarships, and services that enable
students to overcome obstacles to completing their nursing education
programs. A few examples of HRSA's Title VIII data below provide
perspective on current Federal investments.
Nurse Faculty Loan Program (NFLP)--BLS projects a need of 35
percent more faculty members to meet the expected increase in demand.
In addition, with 10,200 current faculty members expected to retire,
34,200 new nursing instructors will be needed by 2022. NFLP supports
the establishment and operation of a loan fund at participating schools
of nursing to assist nurses in completing their graduate education to
become qualified nurse faculty. Ongoing NFLP support for faculty
production is critical to building the pipeline that assures the full
capacity of the Nation's future nursing workforce. Targeting a portion
of those funds for minority faculty preparation is fundamental to
achieving that goal. In fiscal year 2012, NFLP grantees exceeded the
program's performance target by 49.6 percent in providing loans to
2,259 students pursuing faculty preparation. About one out of every
four students receiving the NFLP loans were considered underrepresented
minorities.
Comprehensive Geriatric Education Program (CGEP)--CGEP provides
support to educate individuals in providing geriatric care for the
elderly. This goal is accomplished through curriculum development and
dissemination, continuing education, and traineeships for individuals
preparing for advanced nursing education degrees. In fiscal year 2012,
CGEP grantees awarded traineeships to 74 students--the majority of whom
(81 percent) were pursuing a Master's Degree in Nursing.
Nurse Education, Practice, Quality, and Retention Grants (NEPQR)--
NEPQR addresses the critical nursing shortage via projects to expand
the nursing pipeline, promote career mobility, provide continuing
education, and support retention. Grants to support recruiting and
retaining nursing assistants and personal and home care aides in
occupational shortage and/or high demand areas trained 4,624 students
during fiscal year 2012. NEPQR also supported expanding the size of BSN
programs and supported nurse-managed health clinics.
Nurse-Managed Health Clinics (NMHC)
NMHCs are a nurse-practice arrangement, managed by advanced
practice registered nurses, that provides primary care or wellness
services. NMHCs are associated with a school, college, university, or
department of nursing, federally qualified health center, or
independent nonprofit health or social services agency.
NMHCs deliver comprehensive primary healthcare services, disease
prevention, and health promotion in medically underserved areas for
vulnerable and specialized populations (e.g., veterans and/or families
of active military). The complexity of care for these patients presents
significant financial barriers, heavily affecting the sustainability of
these clinics. While providing access points in areas where primary
care providers are in short supply, expansion of NMHCs also increases
the number of structured clinical teaching sites available to train
nurses and other primary care providers. In fiscal year 2012, more than
1,600 health professions students were trained in NMHCs, where the
majority of NMHCs and associated training sites were primarily located
in medically underserved communities (97 percent) and served as a
primary care setting for their local community (65 percent).
Appropriating $20 million in fiscal year 2015 to NMHCs would increase
access to primary care for thousands of underserved people.
The NLN can state with authority that the deepening health
inequities, inflated costs, and poor quality of healthcare outcomes in
this country will not be reversed until the concurrent shortages of
nurses and qualified nurse educators are addressed. Your support will
help ensure that nurses exist in the future who are prepared and
qualified to take care of you, your family, and all those who will need
our care. Without national efforts of some magnitude to match the
healthcare reality facing our Nation today, an under resourced nurse
education and its adverse effect in healthcare generally will be
difficult to avoid.
The NLN urges the subcommittee to maintain the Title VIII Nursing
Workforce Development Programs by funding them at a level of $251
million in fiscal year 2015. We also recommend that the Title III
Nurse-Managed Health Clinics be funded at $20 million in fiscal year
2015.
[This statement was submitted by Beverly Malone, PhD, RN, FAAN,
Chief Executive Officer, National League for Nursing.]
______
Prepared Statement of the National MPS Society
The National MPS Society supports research to find cures for
Mucopolysaccharidoses (MPS) and related diseases, and provides hope and
support for affected individuals and their families through research,
advocacy, and awareness of these devastating disorders. The Society
submits this testimony to request insertion of language in the fiscal
year 2015 Appropriations to direct the National Institutes of Health
(NIH) to fund MPS research.
MPS diseases are rare genetic diseases that affect both children
and adults. They cause progressive damage to cells in the body,
resulting in severe disability and early death. There are currently few
treatments and no cures. There are 11 types of MPS but only 4 FDA
approved enzyme replacement therapy treatments to slow disease
progression. The damage from MPS results in severe problems, including
profound intellectual disabilities, heart disease, vision loss, speech
and hearing impairment, short stature, stiff joints, and pain, among
others. MPS diseases are devastating for children and families, largely
due to the progressive nature of the diseases. Babies are often born
looking perfectly healthy. It is only later, as cell damage becomes
worse, that parents receive the heartbreaking diagnosis. All MPS
diseases are terminal with most affected individuals not surviving
beyond teenage years.
The National MPS Society is requesting the insertion of language
specific to MPS and related diseases into the fiscal year 2015
Appropriations Bill. This language will help focus NIH research efforts
related to MPS and related diseases. After several years of decreased
funding, the NIH budget for MPS research increased between 2010 through
2013 but saw a significant decline in 2014 due to sequestration.
Researchers focused on MPS diseases get almost all of their funding
from the NIH. There is very little private funding for MPS and related
diseases research. Although there are very few therapies for MPS
diseases, the ones that are available are the result of NIH-funded
research. Prominent researchers in the field believe that continued
research holds the promise of effective treatments and cures for MPS
diseases, including stem cell therapies, gene therapies, and small
molecule therapies. Researchers are beginning to build momentum in
their work on MPS diseases. Increased funding for MPS and related
diseases research will ensure that this momentum translates into
progress toward new treatments and a cure. Reduced funding stalls
progress and prevents these critical gains.
On behalf of the children and families impacted by MPS diseases,
the National MPS Society respectfully requests the insertion of the
following language into the fiscal year 2015 Appropriations Bill.
Mucopolysaccharidoses: The Committee encourages the NINDS and NIDDK
to expand research efforts in the development of effective treatments
for MPS diseases. The Committee commends the National Institute of
Neurological Disorders and Stroke (NINDS) and the Office of Rare
Diseases Research (ORDR) and National Institute of Diabetes and
Digestive and Kidney Diseases (NIDDK) for sponsoring scientific
conferences like the Gordon Research Conference (April 2013) focusing
on basic science of lysosomal biology and function but with strong
emphasis on pathogenic mechanisms of lysosomal disease. The Committee
further acknowledges and applauds the National Institutes of Health
ORDR, NINDS and NIDDK for their work related to the Rare Diseases
Clinical Research Network (RDCRN) over the next 5 years to fund
research consortia including lysosomal diseases: mucopolysaccharidosis
(MPS), and MPS bone disease, helping to create additional opportunities
for small research communities, such as the Lysosomal Disease Network,
to address some of these clinical research needs.
Mucopolysaccharidoses (MPS) are a group of genetic, progressive
diseases that are caused by the absence or malfunctioning of certain
enzymes needed to break down molecules called glycosaminoglycans--long
chains of sugar carbohydrates in each of our cells. When mutations
occur in the genes for the enzymes involved in the normal turnover of
Mucopolysaccharidoses, excess amounts of them are stored in the body,
causing progressive damage to a number of different organs and tissues,
and, in most cases, early death. There are no current cures for MPS,
although stem cell transplants and enzyme replacement therapy show
potential for reducing symptom severity. Treatment for the skeletal
abnormalities remains a challenge due to the difficulty of introducing
replacement enzymes or transplanted cells into skeletal tissues.
Although the greatest benefit is likely to be discovered through MPS
research supported by other NIH components, ongoing research at the
NIAMS in other areas of skeletal research may help to inform the
science base and potentially improve the quality of life of patients
with the disease.
Action taken or to be taken: The Committee encourages NINDS, ORDR
and NIDDK to continue supporting scientific conferences in the
Mucopolysaccharidoses and other Lysosomal Disease research community,
such as the Lysosomal Disease Network's Annual WORLD Symposium. This
international conference gives researchers an opportunity to share
findings in basic, translational and clinical research and to establish
collaborations that could enable multicenter studies in natural history
and other areas of clinical research. In addition, this Symposium
promotes interaction among interested lay participants and medical and
scientific experts, in addition to representatives from pharmaceutical
industry, involved in lysosomal diseases.
The intent of the report language is to focus and encourage the
National Institutes of Health's efforts with respect to the direction
of Mucopolysaccharidoses and other Lysosomal Disease related research.
The language included annually in the LHHS report has consistently
addressed some of the most pressing, scientific needs in this complex
area of biomedical research. The outcome has been, and one would hope
continue to be, the Institutes examination of the issues raised by the
Committee so that it can make meaningful efforts to enhance NIH
activity on these important Mucopolysaccharidoses and Lysosomal Disease
research issues.
______
Prepared Statement of the National Multiple Sclerosis Society
Mr. Chairman and Members of the Subcommittee, thank you for this
opportunity to provide testimony regarding funding of critically
important Federal programs that impact those affected by multiple
sclerosis. We urge the Subcommittee to provide the following in fiscal
year 2015: $2.5 million for the Lifespan Respite Care Program; at least
$32 billion for the National Institutes of Health (NIH); robust support
for Medicare and Medicaid; and $12.6 billion for the Social Security
Administration (SSA).
Multiple sclerosis (MS) is an unpredictable, often disabling
disease of the central nervous system that interrupts the flow of
information within the brain, and between the brain and body. Symptoms
range from numbness and tingling to blindness and paralysis. The
progress, severity, and specific symptoms of MS in any one person
cannot yet be predicted. Most people with MS are diagnosed between the
ages of 20 and 50, with at least two to three times more women than men
being diagnosed with the disease.
The National MS Society sees itself as a partner to the Government
in many critical areas. As we advocate for NIH research, we do so as an
organization that in 2013, funded approximately $48 million in MS
research through funds generated through the Society's fundraising
efforts. And as we advocate for Lifespan Respite funding, we do so as
an organization that works to provide some level of respite relief for
caregivers. So while we're here to advocate for Federal funding, we do
it as an organization that commits tens of millions of dollars each
year to similar or complementary efforts as those being funded by the
Federal Government.
Lifespan Respite Care Program
Up to one quarter of individuals living with MS require long-term
care services at some point during the course of the disease. Often, a
family member steps into the role of primary caregiver. According to a
2011 AARP report, 61.6 million family caregivers provided care at some
point during 2009 and the value of their uncompensated services was
approximately $450 billion per year. Family caregivers allow the person
living with MS to remain home for as long as possible and avoid
premature admission to costlier institutional facilities.
Family caregiving, while essential, can be draining and stressful.
A 2012 National Alliance for Caregiving (NAC) survey of individuals
providing care to people living with MS shows that on average,
caregivers spend 24 hours a week providing care. Sixty 4 percent of
caregivers were emotionally drained, 32 percent suffered from
depression and 22 percent have lost a job due to caregiving
responsibilities.
The Lifespan Respite Care Program, enacted in 2006 under President
Bush, provides competitive grants to States to establish or enhance
statewide lifespan respite programs that better coordinate and increase
access to quality respite care. Respite offers professional short-term
help to give caregivers a break from the stress of providing care and
has been shown to provide family caregivers with the relief necessary
to maintain their own health and bolster family stability. Perhaps the
most critical aspect of the program for people living with MS is that
Lifespan Respite serves families regardless of special need or age--
literally across the lifespan. Much existing respite care has age
eligibility requirements and since MS is typically diagnosed between
the ages of 20 and 50, Lifespan Respite programs are often the only
open door to needed respite services.
For these reasons, the National MS Society asks that Congress
provide $2.5 million for the Lifespan Respite Care Program in fiscal
year 2015.
National Institutes of Health
As mentioned previously, the National MS Society invested $48
million to MS research in 2013 and sees the NIH as an invaluable
partner to stop MS in its tracks, restore function and end MS forever.
Approximately $115 million of fiscal year 2013 was directed to MS-
related research and over the years, NIH research projects have helped
make significant progress in understanding MS. NIH scientists were
among the first to report the value of MRI in detecting early signs of
MS and have enhanced knowledge about how the immune system works and
its role in the development of MS lesions.
Twenty years ago, there were no MS therapies or medications--now
there are ten. The NIH provided the basic research necessary so that
these therapies could be developed. Despite this progress, there are
still no treatments approved for people living with progressive MS.
Only with continued investment will the innovation momentum continue,
allowing us to find successful treatments for those with progressive MS
and a cure for all.
The NIH also directly supports jobs in all 50 States and 17 of the
30 fastest growing occupations in the U.S. are related to medical
research or healthcare. More than 83 percent of the NIH's funding is
awarded through almost 50,000 competitive grants to more than 325,000
researchers at over 3,000 universities, medical schools, and other
research institutions in every State.
For these reasons, the Society urges Congress to provide at least
$32 billion for the NIH in fiscal year 2015.
Centers for Medicare & Medicaid Services
Medicare: It is estimated that over 20 percent of the MS population
relies on Medicare as its primary insurer. The majority of these
individuals are under the age of 65 and receive the Medicare benefit as
a result of their disability. Of particular importance to the MS
community are: having appropriate reimbursement levels for Medicare
physicians, maintaining access to diagnostics and durable medical
equipment, protecting access to needed speech, physical and
occupational therapy services, and discouraging overly burdensome cost-
sharing for prescription drugs.
Medicaid: Medicaid provides comprehensive health coverage to over
eight million persons living with disabilities, plus six million
persons with disabilities who rely on Medicaid to fill Medicare's gaps.
The latest statistics (which are pre-recession) show that about 5-10
percent of people with MS have Medicaid coverage. The most recently
available data (2007) reveals that the average annual direct and
indirect (e.g. lost wages) cost for someone with MS in the U.S. is
approximately $69,000. After years of paying to manage their disease,
some people with MS have spent the vast majority of their earnings and
savings, making their financial situation so dire that Medicaid becomes
their only option for health coverage.
The National MS Society urges Congress to maintain funding for
Medicaid and reject proposals to cap or block grant the program. Any of
these proposals would merely shift costs to States, forcing States to
shoulder a seemingly insurmountable financial burden or cut services on
which our most vulnerable rely. The Society also urges Congress to
protect and promote access to home- and community-based care in line
with the 1999 U.S. Supreme Court decision Olmstead.
Social Security Administration
Because of the unpredictable nature and sometimes serious
impairment caused by the disease, SSA recognizes MS as a chronic
illness or ``impairment'' that can cause disability severe enough to
prevent an individual from working. During such periods, people living
with MS are entitled to and rely on Social Security Disability
Insurance (SSDI) or Supplemental Security Income (SSI) benefits to
survive. The National MS Society urges Congress to provide $12.3
billion for the SSA's administrative budget so that it can continue
efforts to reduce hearings and disability backlogs, pay monthly
benefits in a timely manner, and determine post-entitlement issues in a
timely manner.
Conclusion
The National MS Society thanks the Committee for the opportunity to
provide written testimony and our recommendations for fiscal year 2015
appropriations. The agencies and programs we have discussed are of
vital importance to people living with MS and we look forward to
continuing to working with the Committee to help move us closer to a
world free of MS. Please don't hesitate to contact me with any
questions.
[This statement was submitted by Ted Thompson, Vice President,
Federal Government Relations.]
______
Prepared Statement of the National Nursing Centers Consortium
On behalf of the National Nursing Centers Consortium (NNCC), I
would like to thank the members of this subcommittee for the
opportunity to submit testimony regarding the importance of
appropriating funds to support nurse-managed health clinics.
Specifically, NNCC and its members request an appropriation of $20
million to support grants to nurse-managed health clinics through the
Nurse Managed Health Clinic grant program under the Health Resources
and Services Administration's Bureau of Primary Health Care in the
Department of Health and Human Services.
NNCC is a 501(c)(3) member association of nonprofit, nurse-managed
health clinics, sometimes called nurse-managed health centers or NMHCs.
Section 254(c)-1a(a)(2) of the Public Health Services Act defines
``nurse-managed health clinic'' as ``a nurse practice arrangement,
managed by advanced practice nurses, that provides primary care or
wellness services to underserved or vulnerable populations and that is
associated with a school, college, university or department of nursing,
federally qualified health center (FQHC), or independent nonprofit
health or social services agency.'' Currently, there are approximately
250 NMHCs in operation throughout the United States. Section 254(c)-1a
also mandates the creation of a Nurse Managed Health Clinic grant
program and authorizes $50 million in grant funding.\1\ The NMHC grant
program was established to provide these clinics with a stable source
of Federal funding that would place them on footing similar to other
safety-net providers. However, to date, funding for the grant program
has not been appropriated.
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\1\ Public Health Services Act, 42 USC Sec. 254(c)-1a(e) (2014).
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The Value of NMHCs and the Need for NMHC Grant Funding
NMHCs Expand Primary Care Workforce Capacity.--The Nation is facing
a primary care crisis that is about to get worse. According to the
Association of American Medical Colleges (AAMC), by 2025 there will be
a dearth of 130,600 physicians, which includes a shortage of 65,800
primary care physicians.\2\ AAMC data also shows that American medical
schools are not graduating enough doctors to meet this need.\3\ The
Congressional Budget Office estimates the Medicaid expansion called for
by the ACA will lead to 11 million new enrollees.\4\ As these new
enrollees establish primary care homes, the burden on the primary care
workforce is likely to increase dramatically. Data from Massachusetts
shows just how bad the problem could get. A study conducted 2 years
after expanding its public coverage found that only 52 percent of
internists in Massachusetts were accepting new patients and one-third
of family physicians were no longer accepting new patients.\5\
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\2\ American Association of Medical Colleges (AAMC). (June 2010).
The impact of healthcare reform on the future supply and demand for
physicians updated projections through 2025.
Retrieved from https://www.aamc.org/download/158076/data/
updated_projections_through
_2025.pdf.
\3\ Dill, M. & Salsberg, E., AAMC Center for Workforce Studies.
(Nov. 2008). The complexities of physician supply and demand. Retrieved
from https://members.aamc.org/eweb/upload/
The%20Complexities%20of%20Physician%20Supply.pdf.
\4\ Congressional Budget Office (CBO). (July 2012). Estimates for
the insurance coverage provisions of the affordable care act updated
for the recent supreme court decision. Retrieved from http://
www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-
CoverageEstimates.pdf.
\5\ Massachusetts Medical Society. (2008). Physician workforce
study: Executive summary. Retrieved from www.massmed.org/workforce.
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NMHCs are primarily managed by nurse practitioners, which make up
the fastest growing segment of primary care providers in the country.
According to the Health Resources and Services Agency, the number of
primary care NPs is expected to grow by 30 percent, from 55,400 in 2010
to 72,100 by 2020.\6\ Because of these growing numbers, policymakers
across the country are calling for nurse practitioners and NMHCs to
assume a greater role in primary care. For example, in its report,
``The Future of Nursing, Leading Change, Advancing Health,'' the
Institute of Medicine (IOM) states, ``advanced practice registered
nurses should be called upon to fulfill and expand their potential as
primary care providers across practice settings based on their
education and competency.'' \7\ When discussing the role of NMHCs, the
IOM report says, ``Nurse-managed health clinics offer opportunities to
expand access; provide quality, evidence-based care; and improve
outcomes for individuals who may not otherwise receive needed care.''
\8\
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\6\ Health Resources and Servs. Admin., Dept. of Health and Human
Services. (November 2013). Projecting the supply and demand for primary
care practitioners through 2020.
Retrieved from http://bhpr.hrsa.gov/healthworkforce/supplydemand/
usworkforce/primarycare/projectingprimarycare.pdf.
\7\ Institute of Medicine (IOM). The future of nursing: Leading
change, advancing health. p. 1-2. Washington, D.C.: National Academies
Press.
\8\ Institute of Medicine (IOM). The future of nursing: Leading
change, advancing health. p. c-4. Washington, D.C.: National Academies
Press.
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Along with the IOM, the National Governor's Association (NGA) and
the National Institute for Health Care Reform (NIHCR) both released
reports identifying the greater use of nurse practitioners as a means
of alleviating the pressure on the primary care workforce and
presenting NP scope of practice law and payment policy reform as
important to ensuring comprehensive access to primary care. Most
recently, in a 2013 study published in Health Affairs, the RAND
Corporation projected that greater use of the nurse-managed health
centers model could address the increased demand for primary care.\9\
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\9\ Auerbach, D. I. (Nov. 2013). Nurse-Managed Health Centers and
Patient-Centered Medical Homes Could Mitigate Expected Primary Care
Physician Shortage. Health Affairs, 32 (11), 1933--41.
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As safety-net providers, NMHCs offer high quality primary care to
medically underserved patients regardless of the patient's ability to
pay. However, NMHCs are struggling financially and often lack access to
FQHC money available to other safety net providers. Thus, the NMHC
grant program was created, providing NMHCs with alternative Federal
funding to ensure their continued ability to meet the needs of their
patients and communities. Because they already serve a high percentage
of Medicaid patients, the clinics are positioned to not only absorb
demand from the newly ensured but also fill gaps in care resulting from
the fragmented application of Medicaid expansion.
To lessen the primary care crisis and ensure the underserved can
take full advantage of the care NMHCs offer, NNCC requests that the
Subcommittee appropriate funding to the NMHC grant program. Evidence
suggests that funding NMHCs will not only expand access but also lower
the cost of care. In addition to lower labor costs, research shows that
NMHCs decrease costs by reducing unnecessary emergency room visits and
hospitalizations.\10\
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\10\ Coddington, J. A. & Sands, L. P. (2008). Cost of healthcare
and quality outcomes of patients at nurse-managed clinics. Nurs. Econ,
26(2), 75-83.
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NMHCs Help Educate the Health Professionals of Tomorrow.--FQHC
funding is often unavailable to NMHCs, because many are affiliated with
academic schools of nursing. Academically-affiliated NMHCs operate
under the jurisdiction of a university, so most cannot meet FQHC
governance requirements without breaking their academic connection and
giving up their clinical programs. Ironically, it is these academic
affiliations that make the NMHC model especially responsive to primary
care shortages, since they contribute to workforce development. NMHCs
naturally serve as community-based clinical training sites for a
diverse group of health profession students including those training to
be registered nurses and advance practice nurses (mostly nurse
practitioners) as well as medical, pharmacy, dental, social work,
public health, and other students. In post-clinical focus groups,
students report being ``overwhelmingly satisfied'' with their
experience in NMHC clinical rotations, crediting, in part, the
community-based experience absent from other clinical rotations.\11\
The Future of Nursing report also praised NMHC clinical programs for
their interprofessional education, which relates to both job
satisfaction and a flexible workforce.\12\
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\11\ Institute for Nursing Centers. (2009). Feedback from student
focus groups.
\12\ Institute of Medicine (IOM). The future of nursing: Leading
change, advancing health. p. c-4. Washington, D.C.: National Academies
Press.
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In 2012, the NNCC conducted a survey of its members to measure
their contribution to health professions education. Twenty-eight NMHCs
in a mix of urban, rural, and suburban communities reported providing
educational opportunities for nearly 1,500 students.\13\ The average
number of students educated by the NMHC grant funded clinics was 80,
while the clinics participating in the 2012 survey reported educating
an average of 55 students. These results demonstrate that (1) NMHCs
advance workforce development and (2) increased funding enhances the
ability of NMHCs to offer educational opportunities.
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\13\ NNCC. (2012). NNCC Membership Survey.
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Despite the benefits of NMHC clinical programs, NMHC leaders are
often forced to abandon this important piece of the NMHC model to
qualify for FQHC funding. By providing an alternative source of funding
for NMHCs, the Nurse-Managed Health Clinic grant program helps to
preserve the contribution of NMHCs to workforce development. Given the
country's growing need for nurses, NNCC respectfully requests that the
subcommittee members appropriate funding to support clinical programs
and place NMHCs on a similar footing with other safety-net providers
through the NMHC grant program.
In October of 2010, HRSA released $14.8 million in Prevention and
Public Health Fund dollars to fund ten NMHC grants. In addition to
serving over 27,000 patients and recording more than 72,000 encounters,
the NMHC grantees have provided interdisciplinary clinical training to
over 800 health profession students annually.\14\
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\14\ National Nursing Centers Consortium (NNCC). (2011). Survey of
NMHCs.
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Request.--The 10 NMHC grants distributed in 2010 will expire this
year if Congress does not move to appropriate funding to the program.
NNCC respectfully requests an appropriation of $20 million in fiscal
year 2015 for the Nurse-Managed Health Clinic Grant Program, as
authorized under Title III of the Public Health Service Act.
[This statement was submitted by Tine Hansen-Turton, CEO, National
Nursing Centers Consortium.]
______
Prepared Statement of the National Respite Coalition
Mr. Chairman, I am Jill Kagan, Chair of the National Respite
Coalition (NRC), a network of respite providers, family caregivers,
national, State and local agencies and organizations who support
respite. Thirty State respite coalitions are also affiliated with the
NRC. This statement is presented on behalf of these organizations. The
NRC also facilitates the Lifespan Respite Task Force, a coalition of
over 100 national, State and local groups who support the Lifespan
Respite Program and its continued funding. We are requesting that the
Subcommittee include $2.5 million for the Lifespan Respite Care Program
administered by ACL/AoA in the fiscal year 2015 Labor, HHS, and
Education Appropriations bill or designate this amount from the
Prevention and Public Health Fund as recommended in the President's
fiscal year 2015 budget. This amount is only modestly above the current
fiscal year 2014 level of $2.3. This will enable:
--State replication of best practices in Lifespan Respite to allow
family caregivers, regardless of the care recipient's age or
disability, to have access to affordable respite, and to be
able to continue to play the significant role in long-term care
that they are fulfilling today, saving Medicaid billions;
--Improvement in the quality of respite services currently available;
--Expansion of respite capacity to serve more families by building
new and enhancing current respite options, including
recruitment and training of respite workers and volunteers; and
--Greater consumer direction by providing family caregivers with
training and information on how to find, use and pay for
respite services.
who needs respite?
A 2012 national survey from the Pew Research Center found that four
in ten adults in the U.S. are caring for an adult or child with
significant health issues, up from 30 percent in 2010 (Fox, S, et al,
2013). The estimated economic value of the unpaid contributions of
family caregivers caring for someone over the age of 18 is
approximately $450 billion. This amount is more than total Medicaid
spending, including both Federal and State contributions for healthcare
and long-term services and supports. If parents caring for children
with special needs are also considered, another $50 to $100 billion
would be added to the economic value of family caregiving (AARP Public
Policy Institute, 2011).
Family caregiving is not just an aging issue, but also a lifespan
one. While the aging population is growing rapidly, the majority of
family caregivers are caring for someone under age 75 (56 percent); 28
percent of family caregivers care for someone between the ages of 50-
75, and 28 percent care for someone under age 50 (National Alliance for
Caregiving (NAC) and AARP, 2009). Many family caregivers are in the
sandwich generation--46 percent of women who are caregivers of an aging
family member and 40 percent of men also have children under the age of
18 at home (Aumann, K, and Galinsky, E, 2008). And 6.7 million children
are in the primary custody of an aging grandparent or other relative.
Families of the wounded warriors, military personnel who returned
from Iraq and Afghanistan with traumatic brain injuries and other
serious chronic and debilitating conditions, don't have full access to
respite. Even with enactment of the VA Family Caregiver Support Program
which serves only veterans since 9/11, the need for respite will remain
high for all veterans and their family caregivers. Caregivers whose
veterans have PTSD are about half as likely as other caregivers to
receive respite (11 percent vs. 20 percent) (NAC, November 2010).
Sixty-eight percent of veterans' caregivers reported their situation as
highly stressful compared to 31 percent of caregivers nationally, and
three times as many say there is a high degree of physical strain (40
percent vs. 14 percent) (NAC, 2010). Veterans' caregivers specifically
asked for up-to-date lists of respite providers in their communities
and help to find services, the very thing Lifespan Respite is charged
to provide (NAC, 2010).
National, State and local surveys have shown respite to be the most
frequently requested service of the Nation's family caregivers (The
Arc, 2011; National Family Caregivers Association, 2011). Other than
financial assistance for caregiving through direct vouchers payments or
tax credits, respite is the number one national policy related to
service delivery that family caregivers prefer (NAC and AARP, 2009).
Yet respite is unused, in short supply, inaccessible, or unaffordable
to a majority of the Nation's family caregivers. The NAC 2009 survey
found that despite the fact that among the most frequently reported
unmet needs of family caregivers were ``finding time for myself'' (32
percent), ``managing emotional and physical stress'' (34 percent), and
``balancing work and family responsibilities'' (27 percent), nearly 90
percent of family caregivers across the lifespan are not receiving
respite services at all.
An estimated 80 percent of all long-term care in the U.S. is
provided at home. This percentage will only rise in the coming decades
with greater life expectancies of individuals with disabling and
chronic conditions living with their aging parents or other caregivers,
the aging of the baby boom generation, and the decline in the
percentage of the frail elderly who are entering nursing homes.
respite barriers and the effect on family caregivers
Barriers to accessing respite include reluctance to ask for help,
fragmented and narrowly targeted services, cost, and the lack of
information about respite or how to find or choose a provider. Even
when respite is an allowable funded service, a critically short supply
of well-trained respite providers may prohibit a family from making use
of a service they so desperately need. Lifespan Respite is designed to
help States eliminate these barriers through improved coordination and
capacity building.
While most families take great joy in helping their family members
to live at home, it has been well documented that family caregivers
experience physical and emotional problems directly related to their
caregiving responsibilities. In a 2009 survey of family caregivers, a
majority (51 percent) who are caring for someone over age 18 have
medium or high levels of burden of care, measured by the number of
activities of daily living with which they provide assistance, and 31
percent were identified as ``highly stressed'' (NAC and AARP, 2009).
Parents of children with special healthcare needs report poorer general
health, more physical health problems, worse sleep, and increased
depressive symptoms compared to parents of typically developing (TD)
children (McBean, A and Schlosnagle, L, 2013).
A family caregiver's declining health status is a risk factor for
care recipient institutionalization. When caregivers lack effective
coping styles or are depressed, care recipients may be at risk for
falling, developing preventable secondary health conditions or
limitations in functional abilities. The risk of abuse from caregivers
among care recipients with significant needs increases when caregivers
themselves are depressed or in poor health (American Psychological
Association, nd).
Supports that would ease family caregiver stress, most importantly
respite, are too often out of reach or completely unavailable.
Restrictive eligibility criteria also preclude many families from
receiving services or continuing to receive services for which they
once were eligible. Children with disabilities will age out of the
system when they turn 21 and they will lose many of the services, such
as respite. A survey of nearly 5000 caregivers of individuals with
intellectual and developmental disabilities (I/DD) conducted by The Arc
found: the vast majority of caregivers report that they are suffering
from physical fatigue (88 percent), emotional stress (81 percent) and
emotional upset or guilt (81 percent) some or most of the time; 1 out
of 5 families (20 percent) report that someone in the family had to
quit their job to stay home and support the needs of their family
member; and more than 75 percent of family caregivers caring for adult
children with developmental disabilities could not find respite
services (The Arc, 2011). Respite may not exist at all in some States
for individuals with Alzheimer's, those under age 60 with conditions
such as ALS, MS, spinal cord or traumatic brain injuries, or children
with serious emotional conditions.
respite benefits families and is cost saving
Respite has been shown to be an effective way to reduces stress and
improve the health and well-being of family caregivers that in turn
helps avoid or delay out-of-home placements, such as nursing homes or
foster care, minimizes the precursors that can lead to abuse and
neglect, and strengthens marriages and family stability. A recent study
of parents of children with autism spectrum disorders found that
respite care was associated with reduced stress and improved marital
quality (Harper, Amber, et al, 2013). A U.S. Department of Health and
Human Services report prepared by the Urban Institute found that
reducing key stresses on caregivers, such as physical strain and
financial hardship, through services such as respite would reduce
nursing home entry (Spillman and Long, USDHHS, 2007). In a survey of
caregivers of individuals with Multiple Sclerosis (MS), two-thirds said
that respite would help keep their loved one at home. When the care
recipient with MS also has cognitive impairment, the percentage of
those saying respite would be helpful to avoid or delay nursing home
placement jumps to 75 percent (NAC, 2012).
The budgetary benefits that accrue because of respite are just as
compelling. Delaying a nursing home placement for just one individual
with Alzheimer's or other chronic condition for several months can save
Medicaid and other government programs thousands of dollars.
Researchers at the University of Pennsylvania studied the records of
over 28,000 children with autism ages 5 to 21 who were enrolled in
Medicaid in 2004. They concluded that for every $1,000 States spent on
respite services in the previous 60 days, there was an 8 percent drop
in the odds of hospitalization (Mandell, David S., et al, 2012). In the
private sector, U.S. businesses lose from $17.1 billion to $33.6
billion per year in lost productivity of family caregivers (MetLife
Mature Market Institute, 2006). Higher absenteeism alone among working
caregivers costs the U.S. economy an estimated $25.2 billion in lost
productivity per year (Witters, D., 2011). Respite for working family
caregivers could help improve job performance and employers could
potentially save billions.
lifespan respite care program will help
The Federal Lifespan Respite program is administered by the
Administration for Community Living (ACL), Administration on Aging
(AoA), U.S. Department of Health and Human Services (HHS). ACL/AoA
provides competitive grants to eligible State agencies in concert with
Aging and Disability Resource Centers (ADRCs) working in collaboration
with State respite coalitions or respite organizations. Congress
appropriated $2.5 million each year from fiscal year 2009--fiscal year
2012 and a slightly lower amount due to sequestration in fiscal year
2013 and fiscal year 2014. Since 2009, 32 States and the District of
Columbia each received three-year $200,000 start-up Lifespan Respite
Grants. Nine States and DC received one-time $150,000 expansion grants
to focus on direct services, especially for those who are unserved. In
the last 2 years, many of the States received 17-month Integration and
Sustainability grants to continue their important work.
The purpose of the law is to expand and enhance respite services,
improve coordination, and improve respite access and quality. States
are required to establish State and local coordinated Lifespan Respite
care systems to serve families regardless of age or special need,
provide new planned and emergency respite services, train and recruit
respite workers and volunteers and assist caregivers in gaining access
to services. Those eligible would include family members, foster
parents or other adults providing unpaid care to adults who require
care to meet basic needs or prevent injury and to children who require
care beyond that required by children generally to meet basic needs.
Lifespan Respite, defined as a coordinated system of community-
based respite services, helps States use limited resources across age
and disability groups more effectively. Provider pools can be
recruited, trained and shared, administrative burdens reduced by
coordinating resources, and savings used to fund new respite services
for families who do not qualify for any Federal or State program.
how is lifespan respite program making a difference?
With limited funds, Lifespan Respite grantees are engaged in
innovative activities such as:
--In TN and RI, the Lifespan Respite program is building respite
capacity by expanding volunteer networks of providers by
recruiting University students or Senior Corps volunteers or
expanding the national TimeBanks model for establishing
voluntary family cooperative respite strategies.
--In Texas, the Lifespan Respite program has established a statewide
Respite Coordination Center, and an online database.
--In SC, the State respite coalition and the Lifespan Respite program
are partnering in new ways with the untapped faith community to
provide respite, especially in rural areas.
--The North Carolina Lifespan Respite Program has challenged each of
its 100 counties to improve respite service delivery locally,
and has partnered with the Money Follows the Person program to
develop family caregiver peer-to-peer support and respite.
--In NH, new providers have been recruited and trained through
partnerships with the NH National Alliance on Mental Illness,
New Hampshire Family Voices, and the College of Direct Support
with funding from the Department of Labor to expand the pool of
respite providers to work with teens and older individuals with
mental health conditions or other groups where respite is in
short supply.
--The AZ Lifespan Respite program housed in Division of Aging and
Adult Services has partnered with their State's Children with
Special Health Care Needs Program to provide respite vouchers
to families in need across the age and disability spectrum.
--The OK Lifespan Respite program partnered with their State's
Federal Transit Administration's Section 5310 transportation
authority to release a van no longer needed to develop mobile
respite to serve isolated rural areas of the State.
Across the board, States are building respite registries and ``no
wrong door systems'' in collaboration with State respite coalitions and
ADRCs to help family caregivers access respite and funding sources. OK,
AL, NV, TN and others are using Lifespan Respite grants to expand or
implement participant-directed respite through voucher systems so that
family caregivers have greater control over the type and quality of the
respite they select. State grantees secure commitments from partnering
State agencies to share information and coordinate resources to build a
seamless Lifespan Respite system for accessing respite.
Funding must be maintained to help sustain these innovative State
efforts. The goal of Lifespan Respite System is to coordinate respite
services and funding, maximize existing resources and leverage new
dollars in both the public and private sectors to build respite
capacity and serve the unserved, but States need more time and fiscal
support to do so. Maintaining funding for the program in fiscal year
2015 could allow several new States to start Lifespan Respite Programs
and help assist at least a few of the remaining grantees to complete
the work that they have started. As it is, given the limited funding
for fiscal year 2014, only 1-2 new States and 5-8 of the current
grantees are expected to be funded. States are working successfully
with ARCH to develop comprehensive sustainability plans, but without
Federal support, many of the grantees will be cut off before they have
had a chance to have a lasting impact.
No other Federal program mandates respite as its sole focus, helps
ensure respite quality or choice, and allows funds for respite start-
up, training or coordination to address accessibility and affordability
issues for families. With tens of millions of families affected,
caregiving is a public health issue requiring an immediate proven
preventive response, such as respite. We urge you to include at least
$2.5 million in the fiscal year 2015 Labor, HHS, and Education
appropriations bill or designate this amount in the Prevention and
Public Health Fund. This will allow Lifespan Respite Programs to be
replicated and sustained. Families, with access to respite, will be
able to maintain their own health and well-being and continue to play
the significant role that they are fulfilling today.
[This statement was submitted by Jill Kagan, Chair, National
Respite Coalition.]
______
Prepared Statement of the National Rural Health Association
The National Rural Health Association (NRHA) is pleased to provide
the Labor, Health and Human Services, Education and Related Agencies
Appropriations Subcommittee with a statement for the record on fiscal
year 2015 funding levels for programs with a significant impact on the
health of rural Americans.
NRHA is a national nonprofit membership organization with a diverse
collection of 21,000 individuals and organizations who share a common
interest in rural health. The Association's mission is to improve the
health of rural Americans and to provide leadership on rural health
issues through advocacy, communications, education and research.
NRHA is advocating support for a group of rural health program that
assist rural communities in maintaining and building a strong
healthcare delivery system into the future. Most importantly, these
programs help increase the capacity of the rural healthcare delivery
system and true safety net providers. Rural Americans, on average, are
poorer, sicker and older than their urban counterparts. Programs in the
rural health safety net increase access to healthcare, help communities
create new health programs for those in need and train the future
health professionals that will care for the 62 million rural Americans.
With modest investments, these programs evaluate, study and implement
quality improvement programs and health information technology systems.
Important rural health programs supported by NRHA are outlined
below.
Rural Health Outreach and Network Grants provide capital investment
for planning and launching innovative projects in rural communities
that later become self-sufficient. These grants are unique in the
Federal system as they allow the community to build a program around
their needs. These grants award funding to develop needed formal,
integrated networks of providers that deliver primary and acute
services. The grants have led to projects including information
technology networks, oral screenings, and preventative care. Due to the
community nature of the grants and a focus on self-sustainability after
the terms of the grant have run out--85 percent of the Outreach
Grantees continue to deliver services 5 full years after Federal
funding ended. Request: $62.7 million.
Rural Health Research and Policy Grants form the Federal
infrastructure for rural health policy. Without these funds, rural
America has no coordinated voice in the Department of Health and Human
Services (HHS). In addition to the expertise provided to agencies such
as the Centers for Medicare and Medicaid Services, this line item also
funds rural health research centers across the country. Additionally,
we urge the Subcommittee to include in report language instructions to
the Office of Rural Health Policy to direct additional funding to the
State rural health associations. Request: $10.3 million.
State Offices of Rural Health are the State counterparts to the
Federal rural health research and policy efforts, and form the State
infrastructure for rural health policy. They assist States in
strengthening rural healthcare delivery systems by maintaining a focal
point for rural health within each State and by linking small rural
communities with State and Federal resources to develop long term
solutions to rural health problems. Without these funds, States would
have diminished capacity to administer many of the critical rural
health programs. The State offices play a key role in assisting rural
health clinics, community health centers, and small, rural hospitals
assess community healthcare needs. This program creates a State focus
for rural health interests, brings technical assistance to rural areas,
and helps frontier communities tap State and national resources
available for healthcare and economic development. In partnership with
other State agencies, the State rural health offices have been
essential in addressing the unique needs of rural communities. Request:
$11.1 million.
Rural Hospital Flexibility Grants fund quality improvement and
emergency medical service projects for Critical Access Hospitals (CAHs)
across the country. The BBA created this essential program to improve
access to essential healthcare services by CAHs, rural hospital
networks and rural emergency medical services. These grants allow
statewide coordination and provide expertise to CAHs for quality
improvement or information technology activities. Also funded in this
line is the Small Hospital Improvement Program (SHIP), which provides
grants to more than 1,500 small rural hospitals (50 beds or less)
across the country to help improve their business operations, focus on
quality improvement and to ensure compliance provisions related to
health information privacy. Request: $47.7 million.
Rural and Community Access to Emergency Devices assist communities
in purchasing emergency devices and training potential first responders
in their use. Defibrillators double a victim's chance of survival after
sudden cardiac arrest, which an estimated 163,221 Americans experience
every year. This program trains lay rescuers and first responders in
their use and places them in public areas where sudden cardiac arrest
is likely to occur. Request: $3.7 million.
The Office for the Advancement of Telehealth supports distance-
provided clinical services and is designed to reduce the isolation of
rural providers, foster integrated delivery systems through network
development and test a range of telehealth applications. Long-term,
telehealth promises to improve the health of millions of Americans,
provide constant education to isolated rural providers and save money
through reduced office visits and hospital care. The OAT leads,
coordinates and promotes the use of telehealth technologies by
fostering partnerships between Federal agencies, States and private
sector groups to create telehealth projects. These approaches are still
new and unfolding and continued investment in the infrastructure and
development is needed. Request: $15.3 million.
National Health Service Corps (NHSC) plays a critical role in
providing primary healthcare services to rural underserved populations
by placing healthcare providers in our Nation's most underserved
communities. Investment in our healthcare workforce is absolutely vital
to support the newly insured population resulting from health reform
and the long-term underserved in isolated rural communities. Programs
like the NHSC help maximize the capacity of our health system to care
for patients. The demand for primary care providers far exceeds the
supply, and the needs of our rural communities continue to grow. The
NRHA supports the President's request to ensure that the NHSC has
access to the dedicated funding through the CHC Fund.
Frontier Community Health Integration Demonstration Program (F-
CHIP) funds development and testing of new models for the delivery of
healthcare services in frontier areas through improving access and
integration of the delivery of healthcare to Medicare beneficiaries.
Frontier Extended Stay Clinic (FESC) a geographically isolated
medical clinic designed to provide primary, emergency, and extended-
stay care 24 hours per day when hospital services are not readily
available. The Federal Office of Rural Health Policy (ORHP) has
provided funding for infrastructure development to four clinics in
Alaska.
Title VII Health Professions Training Programs (with a significant
rural focus):
--Area Health Education and Centers (AHECs) financially support and
encourage those training to become healthcare professionals to
practice in rural areas. Without this experience and support
while in medical school, far fewer professionals would make the
commitment to rural areas and facilities including Community
Health Centers, Rural Health Clinics and rural hospitals. The
AHEC Programs and Centers play a critical national role in
addressing healthcare workforce shortages, particularly those
in primary care through an established infrastructure. The
program grantees support the recruitment and retention of
physicians, students, faculty and other primary care providers
in rural and medically underserved areas by providing local,
community-based, interdisciplinary primary care training.
Educating and training rural healthcare providers ensures a
sound future in the delivery of rural healthcare. It has been
estimated that nearly half of AHECs would shut down without
Federal funding. Request: $75 million.
--Rural Physician Pipeline Grants will help medical colleges develop
special rural training programs and recruit students from rural
communities, who are more likely to return to their home
regions to practice. This ``grow-your-own'' approach is one of
the best and most cost-effective ways to ensure a robust rural
workforce into the future. Request: $4.4 million.
--Geriatric Programs train health professionals in geriatrics,
including funding for Geriatric Education Centers (GEC). There
are currently 47 GECs nationwide that ensure access to
appropriate and quality healthcare for seniors. Rural America
has a disproportionate share of the elderly and could see a
shortage of health providers without this program. Request:
$36.7 million.
The National Rural Health Association appreciates the opportunity
to provide our recommendations to the Subcommittee. These programs are
critical to the rural health delivery system and help maintain access
to high quality care in rural communities. We greatly appreciate the
support of the Subcommittee and look forward to working with Members of
the Subcommittee to continue making these important investments in
rural health.
______
Prepared Statement of the National Safety Council
Chairman Harkin, Ranking Member Moran, and Members of the
subcommittee, thank you for the opportunity to submit testimony
regarding the National Safety Council's workplace safety appropriations
priorities. My name is Jim Johnson, and I am Vice President of
Workplace Safety Initiatives at the National Safety Council. We are a
100 year-old Congressionally chartered nonprofit safety organization
dedicated to saving lives by preventing injuries and deaths at work, in
homes and communities, and on the roads through leadership, research,
education, and advocacy. Our more than 14,000 member companies
represent over 8 million employees at more than 51,000 worksites. Today
I am seeking support for $565.01 million for the Occupational Safety
and Health Administration (OSHA) and $332.86 million for the National
Institute for Occupational Safety and Health (NIOSH), two organizations
whose work is vitally important to the mission of safety.
Occupational Safety and Health Administration
The National Safety Council believes that an effective and
efficient OSHA is important for the safety of American workers and
workplaces. NSC supports stable funding for OSHA that adequately funds
all the agency's key functions, including compliance assistance and
support to companies striving for safety excellence, the timely
promulgation of regulations to protect America's workers, enforcement
actions against companies that fail to comply with OSHA standards, and
whistle blower protection for workers.
The Council supports the top line funding level of $565.01 million
for the agency included in the President's fiscal year 2015 budget
request, and we strongly encourage the committee to fund the agency at
a minimum of this funding level. While the Council is pleased that OSHA
rulemaking and enforcement efforts in fiscal year 2014 have been
restored to pre-sequester funding levels, we continue to have strong
concerns about funding constraints placed on the agency's Federal
compliance assistance efforts, which are presently funded at $69.4
million, more than 9 percent less than fiscal year 2012 enacted levels.
Of special concern to the Council is the impact that reduced
compliance assistance funding has had on the agency's Voluntary
Protection Programs (VPP). We encourage the committee to include report
language recommending that VPP receive no less than $3 million in
fiscal year 2015.
VPP were created by OSHA in 1982 as a way of recognizing those
employers who successfully implement effective safety and health
management systems and maintain injury and illness rates below the
national average for their industries. Under VPP, company stakeholders
establish a relationship with OSHA based on a cooperative partnership.
Because of this, approval into VPP is as much a proactive effort as it
is recognition of hard work and effort put in by employers and
employees to achieve exceptional records in occupational safety and
health.
The pursuit of VPP status has helped many safety professionals
encourage their employers' leadership to improve safety management
systems by complying with the program's criteria. Organizations with
VPP status represent business leaders who have implemented strong
safety management systems and demonstrated a commitment to continuous
improvement. VPP sites have a Days Away Restricted or Transferred
(DART) case rate of 52 percent below the industry average. The majority
of VPP sites have less than 100 employees.
However, despite the success of this program, recent budget
constraints have required the agency to slow the growth in the number
of new cooperative program participants. Following sequestration in
fiscal year 2013, OSHA only reapproved sites that could be visited
through local travel. As it stands, OSHA is not scheduling new VPP site
approvals until a region's backlog of re-approvals of existing VPP
facilities is eliminated. Minimum funding at a level of at least $3
million will ensure that OSHA has the resources necessary to address
the backlog of re-approvals of existing VPP facilities and to begin to
approve new VPP sites.
National Institute for Occupational Safety and Health
Funding NIOSH at the fiscal year 2014 program level of $332.86
million at a minimum, and preserving the fiscal year 2014 level of $24
million for the Institute's Agriculture, Forestry and Fishing (AgFF)
Sector Program and $27.5 million for the Education and Research Centers
(ERCs), is essential to ensuring that NIOSH can fulfill its mission of
saving lives and preventing injuries.
Finally, I would like to focus on the important role that NIOSH
programs play in reducing workplace injuries and fatalities. NIOSH's
primary responsibility is to conduct research and make recommendations
for the prevention of work-related injuries and illnesses. NIOSH works
to ensure the health and safety of the American workforce through
research, education and training. It is not a regulatory agency, and
can only issue recommendations for health and safety standards. The
Council is disheartened to see the President's budget request again
target the Institute's Agriculture, Forestry and Fishing (AgFF) Sector
Program and Education and Research Centers (ERCs) by eliminating their
budget.
NIOSH established the AgFF program in 1990 in response to evidence
that agricultural workers were suffering higher rates of injury and
illness than other U.S. workers. The agriculture, forestry, and
fishing, industry fatality rate is more than 8 times that of the all-
industry average. Yearly, almost 18,000 workers in this sector are
injured seriously enough to require time away from work.\1\ Daily, an
average of over 330 workers in this sector sustain injuries serious
enough to require medical consultation, and nearly 2 workers die from
an injury suffered at work.\2\ Today, the initiative includes nine
regional centers and one national center to address children's farm
safety. These centers conduct vital research leading to evidence-based
standards that save lives. The AgFF Program is the only substantive
Federal effort to meet the obligation to ensure safe conditions for
workers in this sector, and it is effective.
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\1\ U.S. Bureau of Labor Statistics, U.S. Department of Labor.
(2013). Table 2. numbers of nonfatal occupational injuries and
illnesses by case type and ownership, selected industries, 2012.
Retrieved February 12, 2014, from http://www.bls.gov/news.release/
osh.t02.htm.
\2\ National Safety Council. (2013). Injury Facts, 2013 Edition.
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NIOSH supports education and research in occupational health
through academic degree programs and research opportunities, primarily
through 18 university-based ERCs located at leading universities around
the country serving all 50 States. The mission of the ERCs is to reduce
work-related injuries and illnesses in the U.S. by performing
prevention research and by educating, through degree programs and
continuing education, high-quality professionals who implement programs
to improve occupational health and safety and minimize the dangers
faced by workers across the country. The ERCs provide programs in a
unique group of disciplines that benefit employers of all sizes and
industries in every part of the country. Currently, the ERCs are
responsible for supplying a good portion of the country's OSH graduates
who will go on to fill professional roles. With an aging occupational
safety and health workforce, and a shortage of qualified OSH
professionals, ERCs are essential to educating the next generation of
professionals.
Thank you again for the opportunity to submit testimony for the
record.
______
Prepared Statement of the National Technical Institute for the Deaf and
Rochester Institute of Technology
Mr. Chairman and Members of the Committee: I am pleased to present
the fiscal year 2015 budget request for the National Technical
Institute for the Deaf (NTID), one of nine colleges of the Rochester
Institute of Technology (RIT), in Rochester, N.Y. Created by Congress
by Public Law 89-36 in 1965, we provide university technical and
professional education for students who are deaf and hard of hearing,
leading to successful careers in high-demand fields for a sub-
population of individuals historically facing high rates of
unemployment and under-employment. We also provide baccalaureate and
graduate-level education for hearing students in professions serving
deaf and hard-of-hearing individuals. NTID students live, study and
socialize with more than 17,000 hearing students on the RIT campus.
Budget Request
On behalf of NTID, for fiscal year 2015 I would like to request
$66,291,000 in Operations. NTID has worked hard to manage its resources
carefully and responsibly and as such is not requesting an increase in
support in 2015. Over the past 2 years we have reduced our workforce by
12 percent (70 positions) and limited our equipment expenditures. We
also reduced our non-personnel expenditures by over 30 percent in such
areas as building and equipment maintenance, instructional supplies,
freelance interpreting, professional travel and student employment.
NTID has also postponed requests for construction funding for critical
and long overdue renovations to a 33-year old building currently
housing three times the number of staff for which it was intended. In
terms of non-Federal revenues, from fiscal year 2006 to fiscal year
2014, student tuition and fees increased by 63 percent to offset the
rising costs of providing a state-of-the-art college education.
Likewise, from fiscal year 2006 to fiscal year 2013, NTID raised almost
$20 million in support from individuals and organizations.
Our fiscal year 2015 request to continue fiscal year 2014 funding
of $66,291,000 in Operations would allow us to maintain a balanced
budget and avoid harmful reductions. Without this funding, we would
have to impose additional limitations in the areas of equipment
purchasing, interpreting and captioning, scholarship support, building
maintenance, and, most importantly, in personnel and enrollment. These
are not the consequences a successful Federal investment should face.
Enrollment
Truly a national program, NTID has enrolled students from all 50
States. In Fall 2013 (fiscal year 2014), we attracted 1,432, the sixth
straight year of more than 1,400 students. For fiscal year 2015, NTID
hopes to maintain this high enrollment, if our operational resources
allow us to do so. Our enrollment history over the last 8 years is
shown below:
NTID ENROLLMENTS: FISCAL YEAR 2007--FISCAL YEAR 2014
--------------------------------------------------------------------------------------------------------------------------------------------------------
Deaf/Hard-of-Hearing Students Hearing Students
-------------------------------------------------------------------------------- Grand
Fiscal Year Interpreting Total
Undergrad Grad RIT MSSE Sub-Total Program MSSE Sub-Total
--------------------------------------------------------------------------------------------------------------------------------------------------------
2014......................................................... 1,195 42 18 1,255 147 30 177 1,432
2013......................................................... 1,269 37 25 1,331 167 31 198 1,529
2012......................................................... 1,281 42 31 1,354 160 33 193 1,547
2011......................................................... 1,263 40 29 1,332 147 42 189 1,521
2010......................................................... 1,237 38 32 1,307 138 29 167 1,474
2009......................................................... 1,212 48 24 1,284 135 31 166 1,450
2008......................................................... 1,103 51 31 1,185 130 28 158 1,343
2007......................................................... 1,017 47 31 1,095 130 25 155 1,250
--------------------------------------------------------------------------------------------------------------------------------------------------------
MSSE: Master of Science in Secondary Education of Deaf/Hard of
Hearing Students
Grad RIT: other graduate programs at RIT
NTID Academic Programs
NTID offers high quality, career-focused associate degree programs
preparing students for specific well-paying technical careers. NTID
also is expanding the number of its transfer associate degree programs
to better serve the higher achieving segment of our student population
seeking bachelor's and master's degrees. These transfer programs
provide seamless transition to baccalaureate studies in the other
colleges of RIT. In support of those deaf and hard-of-hearing students
enrolled in the other RIT colleges, NTID provides a range of access
services (including sign language interpreting, real-time speech-to-
text captioning, and notetaking) as well as tutoring services. One of
NTID's greatest strengths is our outstanding track record of assisting
high-potential students to gain admission to, and graduate from, the
other colleges of RIT at rates comparable to their hearing peers.
A cooperative education (co-op) component is an integral part of
academic programming at NTID and prepares students for success in the
job market. A co-op gives students the opportunity to experience a
real-life job situation and focus their career choice. Students develop
technical skills and enhance vital personal skills such as teamwork and
communication, which will make them better candidates for full-time
employment after graduation. Almost 300 students last year participated
in 10-week co-op experiences that augment their academic studies,
refine their social skills, and prepare them for the competitive
working world.
Student Accomplishments
For our graduates, over the past 5 years, an average of 91 percent
have found jobs commensurate with their education level. Of our fiscal
year 2012 graduates (the most recent class for which numbers are
available), 93 percent were employed 1 year later, with 65 percent
employed in business and industry, 24 percent in education/non-profits,
and 11 percent in government.
Graduation from NTID has a demonstrably positive effect on
students' earnings over a lifetime, and results in a notable reduction
in dependence on Supplemental Security Income (SSI) and Social Security
Disability Insurance (SSDI). In fiscal year 2012, NTID, the Social
Security Administration, and Cornell University examined earnings and
Federal program participation data for approximately 16,000 deaf and
hard-of-hearing individuals who applied to NTID over our entire
history. The studies show that NTID graduates over their lifetimes are
employed at a much higher rate, earn substantially more (therefore
paying significantly more in taxes), and participate at a much lower
rate in SSI and SSDI than students who withdrew from NTID.
Using SSA data, at age 50, 78 percent of NTID deaf and hard-of-
hearing graduates with bachelor degrees and 73 percent with associate
degrees report earnings, compared to 58 percent of NTID deaf and hard-
of-hearing students who withdrew from NTID. Equally important is the
demonstrated impact of an NTID education on graduates' earnings. At age
50, $58,000 is the median salary for NTID deaf and hard-of-hearing
graduates with bachelor degrees and $41,000 for those with associate
degrees, compared to $34,000 for deaf and hard-of-hearing students who
withdrew from NTID. Higher earnings, of course, yield higher tax
revenues.
An NTID education also translates into reduced dependency on
Federal transfer programs, such as SSI and SSDI. At age 40, less than 2
percent of NTID deaf and hard-of-hearing associate and bachelor degree
graduates participated in the SSI program compared to 8 percent of deaf
and hard-of-hearing students who withdrew from NTID. Similarly, at age
50, only 18 percent of NTID deaf and hard-of-hearing bachelor degree
graduates and 28 percent of associate degree graduates participated in
the SSDI program, compared to 35 percent of deaf and hard-of-hearing
students who withdrew from NTID.
Access Services
NTID provides an access services system to meet the needs of a
large number of deaf and hard-of-hearing students enrolled in
baccalaureate and graduate degree programs in RIT's other colleges as
well as students enrolled in NTID programs who take courses in the
other colleges of RIT. Access services also are provided for events and
activities throughout the RIT community. Access services include sign
language interpreting, real-time captioning, classroom notetaking
services, captioned classroom video materials, and Assistive Listening
Services.
As enrollments have steadily increased, so has the demand for
access services. In fiscal year 2013, 145,003 hours of interpreting
were provided--an increase of 27 percent compared to fiscal year 2008.
In fiscal year 2013, 18,263 hours of real-time captioning were provided
to students--a 9 percent increase over fiscal year 2008. The increase
in demand is partly a result of the increase in the number of students
enrolled in baccalaureate programs at RIT and the number of students
with cochlear implants. In fiscal year 2014, there were 526 deaf and
hard-of-hearing students enrolled in baccalaureate programs at RIT, a
19 percent increase compared to fiscal year 2008, and 360 students with
cochlear implants, a 47 percent increase over fiscal year 2008.
Summary
It is extremely important that our fiscal year 2015 funding request
be granted in order that we might continue our mission to prepare deaf
and hard-of-hearing people to excel in the workplace. NTID has shown
through hard data that our graduates have higher salaries, pay more
taxes, and depend less on Federal SSI/SSDI payments than their
counterparts who do not attend NTID. Our employment rate is 91 percent
over the past 5 years--even more remarkable given the state of the
economy. Demand for an NTID education is higher than ever. Therefore, I
ask that you please consider funding our fiscal year 2015 request of
$66,291,000 for Operations.
We are hopeful that the members of the Committee will agree that
NTID, with its long history of successful stewardship of Federal funds
and outstanding educational record of service with people who are deaf
and hard of hearing, remains deserving of your support and confidence.
Likewise, we will continue to demonstrate to Congress and the American
people that NTID is a proven economic investment in the future of young
deaf and hard-of-hearing citizens. Quite simply, NTID is a Federal
program that works.
[This statement was submitted by Dr. Gerard J. Buckley, President,
National Technical Institute for the Deaf, and Vice President and Dean,
Rochester Institute of Technology. ]
______
Prepared Statement of the National Violence Prevention Network
Thank you for this opportunity to submit testimony in support of
increased funding for the National Violent Death Reporting System
(NVDRS), which is administered by the National Center for Injury
Prevention and Control at the Centers for Disease Control and
Prevention (CDC). The National Violence Prevention Network, a broad and
diverse alliance of health and welfare, suicide and violence
prevention, and law enforcement advocates supports increasing the
fiscal year 2015 funding level to $25 million to allow for nationwide
expansion of the NVDRS program. fiscal year 2014 NVDRS funding is $11.2
million.
background
Each year, about 55,000 Americans die violent deaths. In addition,
an average of 105 people (22 of which are military veterans) take their
own lives each day.
The NVDRS program makes better use of data that are already being
collected by health, law enforcement, and social service agencies. The
NVDRS program, in fact, does not require the collection of any new
data. Instead it links together information that, when kept in separate
compartments, is much less valuable as a tool to characterize and
monitor violent deaths. With a clearer picture of why violent deaths
occurs, law enforcement, public health officials and others can work
together more effectively to identify those at risk and target
effective preventive services.
Currently, NVDRS funding levels only allow the program to operate
in 18 States, including Alaska, Colorado, Georgia, Kentucky, Maryland,
Massachusetts, Michigan, New Jersey, New Mexico, North Carolina, Ohio,
Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, and
Wisconsin. Several other States have expressed an interest in joining
once new funding becomes available. While NVDRS is beginning to
strengthen violence and suicide prevention efforts in the 18
participating States, non-participating States continue to miss out on
the benefits of this important public health surveillance program.
nvdrs in action
Child abuse and other violence involving children and adolescents
remains a problem in America, and it is only through a comprehensive
understanding of its root causes that these needless deaths can be
prevented. Studies suggest that between 3.3 and 10 million children
witness some form of domestic violence annually. Additionally, 1,560
children died as a result of abuse or neglect in 2010.
Children are most vulnerable and most dependent on their caregivers
during infancy and early childhood. Sadly, NVDRS data has shown that
young children are at the greatest risk of homicide in their own homes.
Combined NVDRS data from Alaska, Maryland, Massachusetts, New Jersey,
Oregon, South Carolina, and Virginia determined that African American
children aged 4 years old and under are more than four times as likely
to be victims of homicide than Caucasian children, and that homicides
of children aged four and under are most often committed by a parent or
caregiver in the home. The data also shows that household items, or
``weapons of opportunity,'' were most commonly used, suggesting that
poor stress responses may be factors in these deaths. Knowing the
demographics and methods of child abusers can lead to more effective,
targeted prevention programs.
Intimate partner violence (IPV) is another issue where NVDRS is
proving its value. While IPV has declined along with other trends in
crime over the past decade, thousands of Americans still fall victim to
it every year. Intimate partner homicides accounted for 30 percent of
the murders of women and 5 percent of the murders of men in 2006,
according to the Bureau of Justice Statistics.
Despite being in its early stages in several States, NVDRS is
already providing critical information that is helping law enforcement
and health and human service officials allocate resources and develop
programs in ways that target those most at risk for intimate partner
violence. For example, NVDRS data shows that while occurrences are
rare, most murder-suicide victims are current or former intimate
partners of the suspect, and a substantial number of victims were the
suspect's offspring. In addition, NVDRS data indicate that women are
about seven times more likely than men to be killed by a spouse, ex-
spouse, lover, or former lover, and most of these incidents occurred in
the women's homes.
nvdrs & va suicides
Although it is preventable, every year more than 38,000 Americans
die by suicide and another one million Americans attempt it, costing
more than $36 billion in lost wages and work productivity. In the
United States today, there is no comprehensive national system to track
suicides. However, because NVDRS includes information on all violent
deaths--including deaths by suicide--information from the system can be
used to develop effective suicide prevention plans at the community,
State, and national levels.
The central collection of this data can be of tremendous value for
organizations such as the Department of Veterans Affairs that are
working to improve their surveillance of suicides. For instance, CDC
determined from national NVDRS data that veterans comprised 20 percent
of all suicide victims. The types of data collected by NVDRS including
gender, blood alcohol content, mental health issues and physical health
issues can help prevention programs better identify and treat at-risk
individuals.
federal role needed
At an estimated annual cost of $25 million for full implementation,
NVDRS is a relatively low-cost program that yields high-quality
results. While State-specific information provides enormous value to
local public health and law enforcement officials, data from all 50
States, the U.S. territories and the District of Columbia must be
obtained to complete the national picture. Aggregating this additional
data will allow us to analyze national trends and also more quickly and
accurately determine what factors can lead to violent death so that we
can devise and disseminate strategies to address those factors.
strengthening and expanding nvdrs in fiscal year 2014
The 2014 Consolidated Appropriations Act recognized the public
health utility of NVDRS in preventing violent deaths and increased
NVDRS funding by roughly $8 million to facilitate continued expansion
of the NVDRS program. With this new funding, NVDRS will expand to
roughly two-thirds of the country. The time is now to complete the
nation-wide expansion of NVDRS by providing an appropriation of $25
million in fiscal year 2015.
We thank you for the opportunity to submit this statement for the
record. The investment in NVDRS has already begun to pay off, as the 18
participating States are adopting effective violence prevention
programs. We believe that national implementation of NVDRS is a wise
public health investment that will assist State and national efforts to
prevent deaths from domestic violence, veteran suicide, teen suicide,
gang violence and other violence that affects communities around the
country. We look forward to working with you secure an fiscal year 2015
NVDRS appropriation of $25 million.
______
Prepared Statement of the Native Hawaiian Education Council
Aloha Chairman Harkin and members of the Senate Committee on
Appropriations, Labor, HHS, and Education Subcommittee: Mahalo, thank
you, for allowing us an opportunity to submit this request for
appropriations.
We are seeking continued funding at pre-sequestration levels for
the Native Hawaiian Education Program (NHEP) that targets the Native
Hawaiian student population. The NHEP is an important part of
fulfilling the trust relationship between the U.S. and Native
Hawaiians, and it helps to improve the educational status of Native
Hawaiians. It is an important element in the Native community's effort
to control its education programs and policies and to achieve
educational parity. NHEP aims to close the education achievement gap
between Native Hawaiians and the general population, and also functions
to fulfill the trust relationship between the United States and Native
Hawaiians, the indigenous people of a once sovereign nation. During the
time of their own sovereignty in the kingdom of Hawai`i, Native
Hawaiians had a higher rate of literacy than citizens of the United
States. The educational achievement gap has occurred during the
intervening years since the loss of Native Hawaiian sovereignty, so
that today Native Hawaiians are among the most disadvantaged groups in
the State.
The NHEP Works
NHEP has been effective over the years in meeting the goals of the
program. For example, NHEA has been instrumental in preserving and
protecting the Native Hawaiian language through funding projects that
are designed to address the use of the Native Hawaiian language in
instruction, one of the priorities named in the NHEA. The number of
speakers nearly doubled in 18 years from 8,872 speakers in 1990 to
16,864 in 2008 (Source: OHA Data Book 2011 Tables 4.19 and 4.44)
The NHEP has funded programs that incorporate culture and
indigenous teaching practices in the classroom that leads to better
outcomes for Native Hawaiian students. An example is the improvement in
the graduation rates for Native Hawaiians and math and reading scores.
Graduation rates for Native Hawaiians between 2002 and 2010 rose from
70 percent to 72.2 percent (Sources: Kamehameha Schools' Native
Hawaiian Education Assessment Update 2009, Fig. 9 and HI DOE 2005-06 to
2009-10).
Similarly, math and reading scores have risen for Native Hawaiians.
The percent of Native Hawaiians scoring ``Proficient or Above `` from
2007 to 2012 rose from 27 percent to 49 percent in math and from 41
percent to 62 percent in reading (Source: Hawaii DOE Longitudinal Data
System ).
School attendance rates in schools with student populations that
are over 50 percent Native Hawaiian have increased from 90.1 percent in
the 2000-01 school year to 91.3 percent in the 2011-12 school year
(Source: Kamehameha Schools' draft Ka Huaka`i update, p. 58)
The Need Still Exists
In spite of the gains that Native Hawaiians have made
educationally, the need for innovative programs to assist Native
Hawaiians to improve their academic performance still exists, since
Native Hawaiians have not yet attained parity with the rest of the
students in the State.
Timely high school graduation rates for students in the State rose
from 77 percent to 79.6 percent in the same time period that it rose
from 70 percent to 72.2 percent for Native Hawaiians (Sources:
Kamehameha Schools' Native Hawaiian Education Assessment Update 2009,
Fig. 9 and HI DOE 2005-06 to 2009-10).
Native Hawaiians still lag behind the rest of the State in academic
performance; however the gap between the Native Hawaiians and others is
decreasing. From 2007 to 2012 the increase in the percentage of Native
Hawaiians scoring ``Proficient or Above `` in math rose 22 percentage
points, while the increase for the State during the same time period
was 21 percentage points. The increase for Native Hawaiians in reading
was even more dramatic during that time period, increasing 21
percentage points compared to the State increase of only 11 percentage
points. Unfortunately those gains were not enough to bring Native
Hawaiians to parity. In 2012 Native Hawaiians were still 10 points
behind the State in the percentage scoring ``Proficient or Above'' in
math and nine points behind in the percentage scoring ``Proficient or
Above'' in reading.
Percent Scoring Proficient or Above
----------------------------------------------------------------------------------------------------------------
2007 2012 Change
----------------------------------------------------------------------------------------------------------------
Native Hawaiians.......................... Math........................ 27% 49% 22
State Totals.............................. Math........................ 38 59 21
Difference.................. -11 -10 ......
Native Hawaiians.......................... Reading..................... 41 62 21
State Totals.............................. Reading..................... 60 71 11
Difference.................. -19 -9 ......
----------------------------------------------------------------------------------------------------------------
Source: Hawaii DOE Longitudinal Data System.
In the area of Native Hawaiian language immersion, although the
gains have been tremendous, the nearly 17,000 speakers in 2008 only
represents 6 percent of the approximately 290,000 Native Hawaiians in
Hawai`i (2010 U.S. Census).
Appropriations Request
The pre-sequestration appropriations level for the NHEP was $34
million. Sequestration reduced the amount by $2 million to $32 million,
which is the amount entered into the President's budget. For such a
small program as the NHEP, the $2 million reduction makes a significant
negative impact on the program. We would like to continue to make gains
in the educational achievement of Native Hawaiians, and request the
pre-sequestration level of $34 million so that we don't lose the
momentum of improvement.
NHEP funds programs to help improve the educational attainment of
Native Hawaiians in ways that are linguistically and culturally aligned
to the needs of our Native students and communities in Hawai`i.
Improving education, particularly for the most depressed groups,
eventually leads to cost savings over time through decreased
incarceration, poor health, and public assistance.(Barnett, W. S., &
Ackerman, D. J. 2006. Costs, benefits, and the long-term effects of
early care and education programs: Cautions and recommendations for
community developers. Journal of the Community Development Society,
37(2), 86-100.) Academic achievement is also correlated with positive
economic outcomes. (Belfield, C. 2008, June. The economic investments
of early education in Hawaii. Issue Brief. Flushing, NY: Queen's
College, City University of New York.)
Please help us sustain the NHEP to its pre-sequestration level in
order to continue the educational gains that have taken this program
years to accomplish.
______
Prepared Statement of the Nephcure Foundation
summary of recommendations for fiscal year 2015
_______________________________________________________________________
--$32 billion for the National Institutes of Health (NIH)
--Provide a corresponding increase to the National Institute of
Diabetes and Digestive and Kidney Diseases (NIDDK)
--Expansion of the FSGS/NS Research Portfolio at NIDDK, the Office of
Rare Diseases Research (ORDR) and the National Institute on
Minority Health and Health Disparities (NIMHD) by funding more
research proposals for Primary Glomerular Disease
_______________________________________________________________________
Thank you for the opportunity to present the views of the NephCure
Foundation regarding research on idiopathic focal segmental
glomerulosclerosis (FSGS) and primary nephrotic syndrome (NS). NephCure
is the only non-profit organization exclusively devoted to fighting
FSGS and the NS disease group. Driven by a panel of respected medical
experts and a dedicated band of patients and families, NephCure works
tirelessly to support kidney disease research and awareness.
NS is a collection of signs and symptoms caused by diseases that
attack the kidney's filtering system. These diseases include FSGS,
Minimal Change Disease and Membranous Nephropathy. When affected, the
kidney filters leak protein from the blood into the urine and often
cause kidney failure, which requires dialysis or kidney
transplantation. According to a Harvard University report, 73,000
people in the United States have lost their kidneys as a result of
FSGS. Unfortunately, the causes of FSGS and other filter diseases are
poorly understood.
FSGS is the second leading cause of NS and is especially difficult
to treat. There is no known cure for FSGS and current treatments are
difficult for patients to endure. These treatments include the use of
steroids and other dangerous substances which lower the immune system
and contribute to severe bacterial infections, high blood pressure and
other problems in patients, particularly child patients. In addition,
children with NS often experience growth retardation and heart disease.
Finally, NS that is caused by FSGS, MCD or MN is idiopathic and can
often reoccur, even after a kidney transplant.
FSGS disproportionately affects minority populations and is five
times more prevalent in the African American community. In a
groundbreaking study funded by NIH, researchers found that FSGS is
associated with two APOL1 gene variants. These variants developed as an
evolutionary response to African sleeping sickness and are common in
the African American patient population with FSGS/NS.
FSGS has a large social impact in the United States. FSGS leads to
end-stage renal disease (ESRD) which is one of the most costly chronic
diseases to manage. In 2008, the Medicare program alone spent $26.8
billion, 7.9 percent of its entire budget, on ESRD. In 2005, FSGS
accounted for 12 percent of ESRD cases in the U.S., at an annual cost
of $3 billion. It is estimated that there are currently approximately
20,000 Americans living with ESRD due to FSGS.
Research on FSGS could achieve tremendous savings in Federal
healthcare costs and reduce health status disparities. For this reason,
and on behalf of the thousands of families that are significantly
affected by this disease, we encourage support for expanding the
research portfolio on FSGS/NS at the NIH.
Encourage FSGS/NS Research at NIH
There is no known cause or cure for FSGS and scientists tell us
that much more research needs to be done on the basic science behind
FSGS/NS. More research could lead to fewer patients undergoing ESRD and
tremendous savings in healthcare costs in the United States.
With collaboration from other Institutes and Centers, ORDR
established the Rare Disease Clinical Research Network. This network
provided an opportunity for the NephCure Foundation, the University of
Michigan, and other university research health centers to come together
to form the Nephrotic Syndrome Study Network (NEPTUNE). NEPTUNE is
developing a database of NS patients who are interested in
participating in clinical trials which would alleviate the problem
faced by many rare disease groups of not having access to enough
patients for research. NephCure urges the subcommittee to continue its
support for RDCRN and NEPTUNE, which has tremendous potential to
facilitate advancements in NS and FSGS research.
The NephCure Foundation is also grateful to NIDDK for issuing
program announcements (PA) that serve to initiate grant proposals on
primary glomerular disease. Two PAs that have recently been issued
utilize the R01 and UM1 mechanisms to award funding for primary
glomerular disease research. NephCure recommends the subcommittee
encourage NIDDK to continue to issue primary glomerular disease PAs.
Due to the disproportionate burden of FSGS on minority populations,
it is appropriate for NIMHD to develop an interest in this research.
NephCure asks the subcommittee to encourage ORDR, NIDDK and NIMHD to
collaborate on research that studies the incidence and cause of this
disease among minority populations. NephCure also asks the Subcommittee
to urge NIDDK and the NIMHD to undertake culturally appropriate efforts
aimed at educating minority populations about primary glomerular
disease.
Thank you for the opportunity to present the views of the FSGS/NS
community. Please contact the NephCure Foundation if additional
information is required.
[This statement was submitted by Irving Smokler, PH.D., President
and Founder, Nephcure Foundation.]
______
Prepared Statement of the Neurofibromatosis Network
Thank you for the opportunity to submit testimony to the
Subcommittee on the importance of continued funding at the National
Institutes of Health (NIH) for research on Neurofibromatosis (NF), a
genetic disorder closely linked to many common diseases widespread
among the American population. We respectfully request that you include
the following report language on NF research at the National Institutes
of Health within your fiscal year 2015 Labor, Health and Human
Services, Education Appropriations bill.
Neurofibromatosis [NF]--The Committee supports efforts to increase
funding and resources for NF research and treatment at multiple NIH
Institutes, including NCI, NINDS, NIDCD, NHLBI, NICHD and NEI. Children
and adults with NF are at significant risk for the development of many
forms of cancer; the Committee encourages NCI to increase its NF
research portfolio in fundamental basic science, translational research
and clinical trials focused on NF. The Committee also encourages the
NCI to support NF centers, NF clinical trials consortia, NF preclinical
mouse models consortia and NF-associated tumor sequencing efforts.
Because NF causes brain and nerve tumors and is associated with
cognitive and behavioral problems, the Committee urges NINDS to
continue to aggressively fund fundamental basic science research on NF
relevant to nerve damage and repair, learning disabilities and
attention deficit disorders. Since NF2 accounts for approximately 5
percent of genetic forms of deafness, the Committee encourages NIDCD to
expand its investment in NF2 basic and clinical research.
On behalf of the Neurofibromatosis (NF) Network, a national
organization of NF advocacy groups, I speak on behalf of the 100,000
Americans who suffer from NF as well as approximately 175 million
Americans who suffer from diseases and conditions linked to NF such as
cancer, brain tumors, heart disease, memory loss, and learning
disabilities. Thanks in large measure to this Subcommittee's strong
support, scientists have made enormous progress since the discovery of
the NF1 gene in 1990 resulting in clinical trials now being undertaken
at NIH with broad implications for the general population.
NF is a genetic disorder involving the uncontrolled growth of
tumors along the nervous system which can result in terrible
disfigurement, deformity, deafness, pain, blindness, brain tumors,
cancer, and even death. In addition, approximately one-half of children
with NF suffer from learning disabilities. NF is the most common
neurological disorder caused by a single gene and is more common than
Muscular Dystrophy and Cystic Fibrosis combined. There are three types
of NF: NF1, which is more common, NF2, which initially involves tumors
causing deafness and balance problems, and Schwannomatosis, the
hallmark of which is severe pain. While not all NF patients suffer from
the most severe symptoms, all NF patients and their families live with
the uncertainty of not knowing whether they will be seriously affected
because NF is a highly variable and progressive disease.
Researchers have determined that NF is closely linked to heart
disease, learning disabilities, memory loss, cancer, brain tumors, and
other disorders including deafness, blindness and orthopedic disorders,
primarily because NF regulates important pathways common to these
disorders such as the RAS, cAMP and PAK pathways. Research on NF
therefore stands to benefit millions of Americans:
Learning Disabilities/Behavioral and Brain Function
Learning disabilities affect one-half of people with NF1. They
range from mild to severe, and can impact the quality of life for those
with NF1. In recent years, research has revealed common threads between
NF1 learning disabilities, autism and other related disabilities. New
drug interventions for learning disabilities are being developed and
will be beneficial to military dependants, as well as the general
population. Research being done in this area includes a clinical trial
of the statin drug Lovastatin, as well as other categories of drugs.
Bone Repair
At least a quarter of children with NF1 have abnormal bone growth
in any part of the skeleton. In the legs, the long bones are weak,
prone to fracture and unable to heal properly; this can require
amputation at a young age. Adults with NF1 also have low bone mineral
density, placing them at risk of skeletal weakness and injury. Research
currently being done to understand bone biology and repair will pave
the way for new strategies to enhancing bone health and facilitating
repair.
Pain Management
Severe pain is a central feature of Schwannomatosis, and
significantly impacts quality of life. Understanding what causes pain,
and how it could be treated, has been a fast-moving area of NF research
over the past few years. Pain management is a challenging area of
research and new approaches are highly sought after.
Nerve Regeneration
NF often requires surgical removal of nerve tumors, which can lead
to nerve paralysis and loss of function. Understanding the changes that
occur in a nerve after surgery, and how it might be regenerated and
functionally restored, will have significant quality of life value for
affected individuals. Light-based therapy is being tested to dissect
nerves in surgery of tumor removal. If successful it could have
applications for treating nerve damage and scarring after injury,
thereby aiding repair and functional restoration.
Wound Healing, Inflammation and Blood Vessel Growth
Wound healing requires new blood vessel growth and tissue
inflammation. Mast cells, important players in NF1 tumor growth, are
critical mediators of inflammation, and they must be quelled and
regulated in order to facilitate healing. Researchers have gained deep
knowledge on how mast cells promote tumor growth, and this research has
led to ongoing clinical trials to block this signaling, resulting in
slower tumor growth. As researchers learn more about blocking mast cell
signals in NF, this research can be translated to the management of
mast cells in wound healing.
New Cancer Treatments
NF can cause a variety of tumors to grow, which includes tumors in
the brain, spinal cord and nerves. NF affects the RAS pathway which is
implicated in 70 percent of all human cancers. Some of these tumor
types are benign and some are malignant, hard to treat and often fatal.
One of these tumor types is malignant peripheral nerve sheath tumor
(MPNST), a very aggressive, hard to treat and often fatal cancer.
MPNSTs are fast growing, and because the cells change as the tumor
grows, they often become resistant to individual drugs. Clinical trials
are underway to identify a drug treatment that can be widely used in
MPNSTs and other hard-to-treat tumors.
The enormous promise of NF research, and its potential to benefit
over 175 million Americans who suffer from diseases and conditions
linked to NF, has gained increased recognition from Congress and the
NIH. This is evidenced by the fact that numerous institutes are
currently supporting NF research, and NIH's total NF research portfolio
has increased from $3 million in fiscal year 1990 to an estimated $18
million in fiscal year 2014. Given the potential offered by NF research
for progress against a range of diseases, we are hopeful that the NIH
will continue to build on the successes of this program by funding this
promising research and thereby continuing the enormous return on the
taxpayers' investment.
We appreciate the Subcommittee's strong support for NF research and
will continue to work with you to ensure that opportunities for major
advances in NF research are aggressively pursued. Thank you.
______
Prepared Statement of the New England Educational Opportunity
Association
On behalf of the low-income, first-generation students and students
with disabilities served by the Federal TRIO Programs (``TRIO'') across
Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and
Vermont, the New England Educational Opportunity Association (``NEOA'')
respectfully requests that the Senate Subcommittee on Labor, Health and
Human Services, and Education boost TRIO funding by $52 million in
fiscal year 2015.
A $52 million funding increase would allow for a total funding
level of $890 million in fiscal year 2015 which, in turn, would allow
TRIO's Student Support Services program to expand its reach by 10
percent and grow to serve 20,000 additional low-income, first-
generation students at colleges and universities across the Nation
during the 2015-2016 academic year. This funding level would also allow
current TRIO programs to sustain the high-quality access and success
services provided to 750,000 students across the Nation as well as
allow for the expansion of these services to include 23,000 more who
stand in need. Such growth is critical as TRIO programs have lost more
than 120,000 students over the last decade. While we are tremendously
grateful for the work of this Subcommittee to restore 95 percent of the
funds lost to sequestration in fiscal year 2014, we would be remiss if
we did not request additional funding so that we may continue to recoup
from earlier losses. If the success of TRIO in New England serves as
any indicator, it becomes clear that greater investment in TRIO is
critical to boosting educational attainment nationally.
More than 42,000 students ranging from middle school through
graduate study participate in TRIO programs across New England.
Throughout the region, stories of student success abound, with strong
statistics to support them. For instance, both the Talent Search and
Upward Bound programs in Rhode Island can boast of 99 percent high
school graduation rates. Moreover, 86 percent of Rhode Island's Talent
Search students go directly onto college as do 90 percent of the Upward
Bound students.
In New Hampshire, a longitudinal study of Student Support Services
(``SSS'') participants at the University of New Hampshire demonstrated
that, compared to eligible non-participants, SSS students exhibited
higher graduation rates, greater improvement in grades, and lower
academic suspension rates. Meanwhile, during fiscal year 2010, Plymouth
State University had a 92 percent retention rate among non-graduating
SSS participants. The SSS program at the University of Bridgeport in
Connecticut can demonstrate similar success. During the 2013-2014
Academic Year, 58 percent of SSS participants made the Dean's List and/
or the President's List as a result of their GPAs.
In recent years, the Educational Opportunity Center (EOC) in
Vermont aided 63 percent of its clients--which include out-of-work
adults and military veterans--in enrolling in postsecondary education
programs for the first time; a similar percentage (61 percent) of
postsecondary ``stop-outs'' re-enrolled in postsecondary education
programs. Similarly, the EOC program in Maine helped more than 900
adult learners enroll in college and assisted nearly 2,000 adults in
developing career and educational plans.
Massachusetts also produces stellar results through its TRIO
programs. Many notable examples are found at the University of
Massachusetts-Boston. For instance, the institution's Veterans Upward
Bound (VUB) program found that 81.5 percent of VUB participants who
enrolled in postsecondary education programs persisted through to a
second year of academic study. Meanwhile, 48 percent of students who
participated in their Ronald E. McNair Postbaccalaureate Achievement
program earned doctoral degrees within 10 years of receipt of their
bachelor's degree.
This is just a sampling of the success sparked by the supportive
services provided by TRIO. We hope that you will strongly consider
these examples when determining funding levels for our program in
fiscal year 2015.
Thank you for your consideration of this request.
[This statement was submitted by Karen Keim, President, New England
Educational Opportunity Association.]
______
Prepared Statement of the New Hampshire Community Loan Fund
Chairman Harkin, Ranking Member Moran, and distinguished Members of
the Appropriations Subcommittee on Labor, Health and Human Services,
Education, and Related Agencies: Helping child-care centers finance
improvements to their facilities has been a key poverty-fighting
strategy of the New Hampshire Community Loan Fund for the last two
decades. We see first-hand what the experts are able to prove: that
quality early learning provides a critical foundation for social and
economic success.
The Community Loan Fund wishes to endorse the testimony of the
National Children's Facilities Network and the network's call for
adequate Federal funding for the acquisition, construction, and
improvement of child-care facilities. Over the last 7 years, New
Hampshire's child-care centers have grown increasingly averse to the
risks associated with investing in capital improvements. The recession
heightened the typical executive director's financial anxiety and that
anxiety persists. Now would be the perfect time for Federal action that
would increase their confidence and encourage investments in their
facilities.
Please let me know if you would like additional information from
us.
[This statement was submitted by Richard A. Minard, Jr., Vice
President, New Hampshire Community Loan Fund.]
______
Prepared Statement of the Nursing Community
The Nursing Community is a forum comprised of 60 national
professional nursing associations that builds consensus and advocates
on a wide spectrum of healthcare and nursing issues surrounding
practice, education, and research. These organizations are committed to
promoting America's health through the advancement of the nursing
profession. Collectively, the Nursing Community represents nearly one
million Registered Nurses (RNs), Advanced Practice Registered Nurses
(APRNs-including certified nurse-midwives, nurse practitioners,
clinical nurse specialists, and certified registered nurse
anesthetists), nurse executives, nursing students, faculty, and
researchers.
For fiscal year 2015, our organizations respectfully request $251
million for the Health Resources and Services Administration's (HRSA)
Nursing Workforce Development programs (authorized under Title VIII of
the Public Health Service Act [42 U.S.C. 296 et seq.]), $150 million
for the National Institute of Nursing Research (NINR) within the
National Institutes of Health (NIH), and $20 million in authorized
funding for the Nurse-Managed Health Clinics (Title III of the Public
Health Service Act). These investments will help ensure that our
Nation's population receives the highest-quality nursing services
possible.
Demand for Nurses Continues to Grow
According to the Bureau of Labor Statistics' (BLS) Employment
Projections for 2012-2022, the expected number of practicing nurses
will grow from 2.71 million in 2012 to 3.24 million in 2022, an
increase of 526,800, or 19.4 percent. The number of job openings due to
demand for registered nursing services and replacements in the
workforce brings the total of RNs needed to 1.053 million by 2022. In
addition, nurse practitioners are one of the fastest growing
occupations according to the BLS projections, noting there will be a
33.7 percent increase in nurse practitioners between 2012-2022.
Two primary factors contribute to this overwhelming demand. First,
America's nursing workforce is aging. A 2013 HRSA report, The U.S.
Nursing Workforce: Trends in Supply and Education, indicates that over
the next 10 to 15 years, the nearly one million RNs over age 50
(comprising approximately one-third of the current workforce), will
reach retirement age. Secondly, America's Baby Boomer population is
aging. This population will require a vast influx of nursing services,
particularly in areas of primary care and chronic illness management. A
significant investment must be made in the education of new nurses to
provide the Nation with the nursing services it demands.
Addressing the Demand: Title VIII Nursing Workforce Development
Programs
For 50 years, the Nursing Workforce Development programs,
authorized under Title VIII of the Public Health Service Act, have
helped to build the supply and distribution of qualified nurses to meet
our Nation's healthcare needs. The Title VIII programs bolster nursing
education at all levels, from entry-level preparation through graduate
study, and provide support for institutions that educate nurses for
practice in rural and medically underserved communities. Today, the
Title VIII programs are essential to ensure the demand for nursing care
is met. Between fiscal year 2005 and 2012 alone, these programs
supported over 450,000 nurses and nursing students, as well as numerous
academic nursing institutions and healthcare facilities.
The American Association of Colleges of Nursing's (AACN) Title VIII
Student Recipient Survey gathers information about Title VIII dollars
and their impact on nursing students. The 2013-2014 survey, which
included responses from over 800 students, indicated that the Title
VIII programs played a critical role in funding these students' nursing
education. The survey showed that 78 percent of the students receiving
Title VIII funding are attending school full-time. By supporting full-
time students, the Title VIII programs are helping to ensure that
students enter the workforce without delay.
The Title VIII programs also address the need for more nurse
faculty. Data from AACN's 2013-2014 enrollment and graduations survey
show that nursing schools were forced to turn away 78,089 qualified
applications from entry-level baccalaureate and graduate nursing
programs in 2013, and faculty vacancy was a primary reason. The Title
VIII Nurse Faculty Loan Program aids in increasing nursing school
enrollment capacity by supporting students pursuing graduate education,
provided they serve as faculty for 4 years after graduation.
--The Nursing Community respectfully requests $251 million for the
Nursing Workforce Development programs in fiscal year 2015.
National Institute of Nursing Research: Foundation for Evidence-Based
Care
As one of the 27 Institutes and Centers at the NIH, the NINR funds
research that lays the groundwork for evidence-based nursing practice.
Nurse scientists at NINR examine ways to improve care models to deliver
safe, high-quality, and cost-effective health services to the Nation.
Our country must look toward the prevention aspect of healthcare as the
vehicle for saving our system from further financial burden, and the
work of NINR embraces this endeavor through research related to care
management of patients during illness and recovery, reduction of risks
for disease and disability, promotion of healthy lifestyles,
enhancement of quality of life for those with chronic illness, and care
for individuals at the end of life.
Moreover, NINR helps to provide needed faculty to support the
education of future generations of nurses. Training programs at NINR
develop future nurse researchers, many of whom also serve as faculty in
our Nation's nursing schools.
--The Nursing Community respectfully requests $150 million for the
NINR in fiscal year 2015.
Nurse-Managed Health Clinics: Expanding Access to Care
NMHCs are healthcare delivery sites managed by APRNs and are
staffed by an interdisciplinary health provider team which may include
physicians, social workers, public health nurses, and therapists. These
clinics are often associated with a school, college, university,
department of nursing, federally qualified health center, or
independent nonprofit healthcare agency. NMHCs serve as critical access
points to keep patients out of the emergency room, saving the
healthcare system millions of dollars annually.
NMHCs provide care to patients in medically underserved regions of
the country, including rural communities, Native American reservations,
senior citizen centers, elementary schools, and urban housing
developments. The populations within these communities are the most
vulnerable to chronic illnesses that create heavy financial burdens on
patients and the healthcare system. NMHCs aim to reduce the prevalence
of disease and create healthier communities by providing primary care
services and educating patients on health promotion practices.
Furthermore, NMHCs serve as clinical education training sites for
nursing students and other health professionals. This is crucial given
that a lack of training sites is commonly identified as a barrier to
nursing school enrollment.
--The Nursing Community respectfully requests $20 million for the
Nurse-Managed Health Clinics authorized under Title III of the
Public Health Service Act in fiscal year 2015.
Without a workforce of well-educated nurses providing evidence-
based care to those who need it most, including our growing aging
population, the healthcare system is not sustainable. The Nursing
Community's request of $251 million for the Title VIII Nursing
Workforce Development programs, $150 million for the National Institute
of Nursing Research, and $20 million for Nurse-Managed Health Clinics
in fiscal year 2015 will help ensure continued access to quality care
provided by America's nursing workforce.
members of the nursing community submitting this testimony
Academy of Medical-Surgical Nurses
American Academy of Ambulatory Care Nursing
American Academy of Nursing
American Assembly for Men in Nursing
American Association of Colleges of Nursing
American Association of Critical-Care Nurses
American Association of Heart Failure Nurses
American Association of Neuroscience Nurses
American Association of Nurse Anesthetists
American Association of Nurse Assessment Coordination
American Association of Nurse Practitioners
American College of Nurse-Midwives
American Nurses Association
American Organization of Nurse Executives
American Pediatric Surgical Nurses Association
American Psychiatric Nurses Association
American Rehabilitation Nurses
American Society for Pain Management Nursing
American Society of PeriAnesthesia Nurses
Association of Community Health Nursing Educators
Association of Nurses in AIDS Care
Association of periOperative Registered Nurses
Association of Public Health Nurses
Association of Women's Health, Obstetric and Neonatal Nurses
Commissioned Officers Association of the U.S. Public Health Service
Dermatology Nurses' Association
Developmental Disabilities Nurses Association
Emergency Nurses Association
Gerontological Advanced Practice Nurses Association
Hospice and Palliative Nurses Association
Infusion Nurses Society
International Society of Psychiatric Nursing
National American Arab Nurses Association
National Association of Clinical Nurse Specialists
National Association of Hispanic Nurses
National Association of Pediatric Nurse Practitioners
National Association of School Nurses
National Black Nurses Association
National Forum of State Nursing Workforce Centers
National Nursing Centers Consortium
National Organization for Associate Degree Nursing
National Organization of Nurse Practitioner Faculties
Nurses Organization of Veterans Affairs
Oncology Nursing Society
Preventive Cardiovascular Nurses Association
Society of Urologic Nurses and Associates
______
Prepared Statement of the Older Americans Act
Mr. Chairman, Ranking Member, and distinguished Members of the
Subcommittee, Oral Health America (OHA), a leading organization
dedicated to changing lives by connecting communities with resources to
increase access to care, education, and advocacy for all Americans,
especially those most vulnerable; is requesting fiscal year 2015
funding for all programs administered under the Older Americans Act
(OAA) be restored to fiscal year 2012 levels. Of particular interest to
OHA is to ensure Title III-D, Disease Prevention and Health Promotion,
is restored to at least $21,000,000 because of the cost-effectiveness
that health education, prevention and promotion programs provide to the
system.
The OAA provides Federal programs that serve to meet the needs of
millions of older Americans. We understand the United States continues
to operate amid a challenging budgetary environment. However, OHA
believes that proper Federal investment in the OAA is critical to keep
pace with the rate of inflation and to meet the needs of this ever-
growing segment of the population through the multitude of services the
OAA provides. Simply stated, proper investment in OAA saves taxpayer
dollars. This is especially evident when it comes to health services.
Health services the emphasize prevention and promotion will help to
reduce disease, leading to the improvement of the overall health and
well-being of America's older adults and resulting in the reduction of
premature and costly medical interventions. OHA strongly contends that
one's health and overall well-being begins with proper oral health.
Background
The population of the United States is aging at an unprecedented
rate. Older adults make up one of the fastest growing segments of the
American population. In 2009, 39.6 million seniors were U.S. residents.
This aging cohort is expected to reach 72.1 million by 2030--an
increase of 82 percent.\1\
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\1\ Administration on Aging. (2013). Aging Statistics. Retrieved
from http://www.aoa.gov/Aging_Statistics/.
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The oral health of older Americans is in a state of decay. The
reasons for this are complex. Limited access to dental insurance,
affordable dental services, community water fluoridation, and programs
that support oral health prevention and education for older Americans
are significant factors that contribute to the unmet dental needs and
edentulism among older adults, particularly those most vulnerable.
While improvements in oral health across the lifespan have been
observed in the last half century, long term concern may be warranted
for the 10,000 Americans retiring daily, as it is estimated that only
9.8 percent of this ``silver tsunami''--baby boomers turning age 65--
will have access to dental insurance benefits.\2\
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\2\ Consumer Survey, National Association of Dental Plans. 2012.
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Dental Health and Disparities.--Older adults experience an
increased risk for oral conditions such as edentulism, oral cancer, and
periodontal disease. The reasons for this vary but are often related to
age-associated physiologic changes, underlying chronic diseases, race,
gender, and the use of various medications. These oral conditions
disproportionately affect persons with low income, racial and ethnic
minorities, and those who have limited or no access to dental
insurance. Older adults with physical and intellectual disabilities and
those persons who are homebound or institutionalized are also at
greater risk for poor oral health.\3\
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\3\ U.S. Department of Health and Human Services. (2000). Oral
Health in America: A Report of the Surgeon General. Retrieved from
http://silk.nih.gov/public/hck1ocv.@www.surgeon.
fullrpt.pdf.
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As examples of these disparities, older African American adults are
1.88 times more likely than their white counterparts to have
periodontitis; \4\ low-income older adults suffer more than twice the
rate of gum disease than their more affluent peers (17.49 verses 8.62
respectively); and Americans who live in poverty are 61 percent more
likely to have lost all of their teeth when compared to those in higher
socioeconomic groups.
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\4\ Borrel, L.N., Burt, B.A., & Taylor, G.W. (2005, October).
Prevalence and Trends in Periodontitis in the USA: from the NHANES III
to the NHANES, 1988 to 2000. Journal of Dental Research,84(10).
Retrieved from http://jdr.sagepub.com/content/84/10/924.abstract.
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Edentulism and Overall Health.--Despite these existing conditions,
recent dental public health trends demonstrate that as the population
at large ages, older Americans are increasingly retaining their natural
teeth.\5\ Today, many older adults benefit from healthy aging
associated with the retention of their natural teeth, improvements in
their ability to chew, and the ability to enjoy a variety of food
choices not previously experienced by earlier generations of their
peers.
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\5\ Dolan, T. A., Atchison, K., & Huynh, T. N. (2005). Access to
Dental Care Among Older Adults in the United States. Journal of Dental
Education, 69(9), 961-974. Retrieved from http://www.jdentaled.org/
content/69/9/961.long.
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Oral health data reveals that many older adults experience adverse
oral health associated with chronic and systemic health conditions. For
example, associations between periodontitis and diabetes have emerged
in recent years, as well as oral conditions such as xerostomia
associated with the use of prescription drugs.\6,7\ Xerostomia,
commonly known as dry mouth, contributes to the inception and
progression of dental caries (cavities). For older Americans, the
occurrence or recurrence of dental caries coupled with an inability to
access treatment may lead to significant pain and suffering along with
other detrimental health effects.
---------------------------------------------------------------------------
\6\ Ira B. Lamster, DDS, MMSc, Evanthia Lalla, DDS, MS, Wenche S.
Borgnakke, DDS, PhD and George W. Taylor, DMD, DrPH. (2008). Journal of
the American Dental Association.
\7\ Fox, Philip C. (2008). Xerostomia: Recognition and Management.
Retrieved from: http://www.colgateprofessional.com.hk/LeadershipHK/
ProfessionalEducation/Articles/Resources/profed_art_access-supplement-
2008-xerostimia.pdf.
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Oral Care Provider Issues.--Although a growing number of older
Americans need oral healthcare, the current workforce is challenged to
meet the needs of older adults. The current dental workforce is aging,
and many dental professionals will retire within the next decade.\2\ A
lack of geriatric specialty programs complicates this problem, and few
practitioners are choosing geriatrics as their field of choice.
While these trends are favorable, adverse oral health consequences
are emerging. Due to reasons stated in this report, together with
increased demand for services, lack of access to dental benefits
through Medicare, increased morbidity and mobility among older adults,
and reduced income associated with aging and retirement, many older
Americans are unable to access oral healthcare services. As a result,
many older adults who have retained their natural teeth are now
experiencing dental problems.
Older Adults' Oral Health in State of Decay
OHA released State of Decay on October 8, 2013, which is a State-
by-State analysis of oral healthcare delivery and public health factors
impacting the oral health of older adults. The report revealed more
than half of the country received a ``fair'' or ``poor'' assessment
when it comes to minimal standards affecting dental care access for
older adults. The top findings of the report were:
--Persistent lack of oral health coverage across much of the Nation.
Forty-two percent of States (21 States) provide either no
dental benefits or provide only emergency coverage through
adult Medicaid Dental Benefits. Nearly 70 percent of older
Americans lack dental insurance, and in the context of a
rapidly aging Nation, this percentage will only likely
increase.
--Strained dental health work force. Thirty-one States (62 percent)
have high rates of Dental Health Provider Shortage Areas
(HPSAs), meeting only 40 percent or less of dental provider
needs.
--Tooth loss remains a signal of suboptimal oral health. Eight States
had strikingly high rates of edentulism, with West Virginia
notably having an adult population that is 33.8 percent
edentate.
--Deficiencies in preventive programs. Thirteen States (26 percent)
have upwards of 60 percent of their residents living in
communities without water fluoridation (CWF), despite
recognition for 68 years that this public health measure
markedly reduces dental caries. Hawaii (89.2 percent) and New
Jersey (86.5 percent) represent the highest rates of citizens
unprotected by fluoridation, an unnecessary public peril.
Moreover, poor oral health has substantial financial implications.
For example, in 2010 alone, between $867 million and $2.1 billion was
spent on emergency dental procedures. When compared to care delivered
in a dentist's office, hospital treatments are nearly ten times more
expensive than the routine care that could have prevented the
emergency. This places a costly yet avoidable burden on both the
individual and the health institutions that must then bear the expense.
In sum, oral health and access to preventive care significantly
impact overall health and expenditure, yet are difficult to maintain--
particularly for older adults--in the Nation's present context of
support systems and healthcare.
How OHA Empowers Older Adults to Meet their Oral Health Needs
Oral Health America's Wisdom Tooth Project aims to change the
lives of older adults especially vulnerable to oral disease. Its goal
is to educate Americans about the oral health needs of older adults,
connect older adults to local resources, and to advocate for policies
that will improve the oral health of older adults. The Wisdom Tooth
Project achieves these goals through five strategies: publications, our
web portal, regional symposia, communications, and demonstration
projects.
In addition to the State of Decay report referenced above, a vital
component of the Wisdom Tooth Project is Toothwisdom.org, which is a
first-of-its-kind website created to connect older adults and their
caregivers to local care and education around the oral health issues
they face, the importance of continuing prevention as we age, and the
overall impact of oral health on overall health.
Importance of OAA Reauthorization to Oral Health of Older Adults
Recognizing this current State of oral health among older adults,
Oral Health America welcomes the bipartisan-supported Older Americans
Act reauthorization in the U.S. Senate, S.1562. The Senate's bill
includes--for the first time--a small provision that allows the Aging
Network to use funds they receive for disease prevention and health
promotion activities to conduct oral health screenings. Preventive
dental care that can be provided through oral health screenings can
head off more expensive dental work and help prevent severe diseases.
Unfortunately, dentists see older adults everyday living with infection
and pain that could be easily avoided with proper care that these
screenings could provide. Although the oral health screenings provision
would not require new or additional funding under Title III-D, Disease
Prevention and Health Promotion Services, restoring funding to fiscal
year 2012 levels would greatly assist the Aging Network to conduct the
screenings. More succinctly, the Senate's bill recognizes the
importance of oral health and its role in disease prevention. We view
this as a step toward improving the oral--and overall--health of older
adults and call for the bill's passage.
recommendation
It is evident the United States' healthcare system is woefully
unprepared to meet the oral health challenges of a burgeoning
population of older adults with special needs, chronic disease
complications, and a growing inability to access and pay for dental
services. However, the benefits of proper oral hygiene and routine care
for older adults to our Nation's healthcare system and economy are also
quite clear. Through OHA's Wisdom Tooth Project, OHA aspires to change
the lives of older adults especially vulnerable to oral disease. OHA
views proper funding of the Older Americans Act as a crucial Federal
investment vehicle to advance health promotion and disease prevention.
Therefore, OHA recommends the Subcommittee to restore fiscal year 2015
funding for all OAA program to fiscal year 2012 levels, and moreover,
to ensure Title III-D, Disease Prevention and Health Promotion, is
restored to at least $21,000,000 because of the cost-effectiveness that
health education, prevention and promotion programs provide to the
system.
Thank you for the opportunity to present and submit our written
testimony before the Subcommittee.
[This statement was submitted by Beth Truett, CEO/President, Oral
Health America.]
______
Prepared Statement of the Ovarian Cancer National Alliance
The Ovarian Cancer National Alliance (the Alliance) greatly
appreciates the opportunity to submit testimony for the record
regarding our fiscal year 2015 funding recommendations. The fiscal year
2015 programmatic funding levels we are advocating for will help
advance the awareness, detection and treatment of ovarian cancer, the
deadliest of gynecologic cancers. Specifically, the Alliance
respectfully requests Congress provide $7.5 million for the Centers for
Disease Control and Prevention's (CDC) Ovarian Cancer program, which
funds critical public health research of ovarian cancer. CDC also leads
a public gynecologic cancer (ovarian, uterine, cervical, vaginal,
vulvar) awareness initiative, authorized by Johanna's Law, that plays
an integral role in women's cancer education, detection and prevention.
As such, the Alliance respectfully requests Congress appropriate $5.5
million for Johanna's Law implementation. Furthermore, to advance and
leverage the important ovarian cancer research funded through the
National Cancer Institute (NCI) at the National Institutes of Health
(NIH), the Alliance respectfully requests Congress allocate $5.26
billion to NCI, as a portion of $32 billion appropriated to NIH in
fiscal year 2015.
For 17 years, the Alliance has worked to increase awareness of
ovarian cancer and advocate on behalf of women with ovarian cancer. As
an umbrella organization of 58 State and regional Partner Member
organizations, the Alliance unites the efforts of survivors, caretakers
and healthcare professionals to bring national attention to ovarian
cancer. The Alliance advocates at a national level for greater
investment in Federal research to support the development of an early
detection test, improved healthcare practices and life-saving treatment
protocols. The Alliance also educates healthcare professionals about--
and raises public awareness of--risk factors for and symptoms of
ovarian cancer.
Ovarian cancer is a highly deadly disease. According to the
American Cancer Society, in 2013, an estimated 22,240 women were
diagnosed with ovarian cancer and 14,030 women lost their lives to this
terrible disease. A quarter of women diagnosed with ovarian cancer will
die within 1 year of diagnosis and over half of women do not survive 5
years after diagnosis. Unfortunately, these rates have not changed in
nearly 40 years. These grim statistics arise from the fact that there
is no early detection test for ovarian cancer; tragically, most cases
of ovarian cancer are diagnosed after the disease has already begun to
spread and are more difficult to effectively treat. However, if ovarian
cancer is caught in the early stages, nearly ninety percent of women
survive. As such, it is critical that women and healthcare providers be
aware of the signs and symptoms of ovarian cancer and that valid and
reliable early detection tests be developed.
Few treatments for ovarian cancer have been approved by the Food
and Drug Administration (FDA). Many FDA approved drugs are platinum-
based therapies, to which cancers readily become resistant if multiple
rounds of chemotherapy are needed. Nearly 80 percent of ovarian cancer
patients will have a recurrence of disease, underscoring the great need
for new and better treatments for ovarian cancer. For these reasons, we
respectfully urge you and your colleagues to support ovarian cancer
research, education and awareness efforts.
cdc division of cancer prevention and control--ovarian cancer
The Ovarian Cancer Line (also known as the Ovarian Cancer Control
Initiative) funds public health research of ovarian cancer to better
identify women most at risk for developing ovarian cancer, and design
risk-reduction and prevention-focused interventions. In fiscal year
2014, CDC's ovarian cancer program received $4.75 million to achieve
its mission. Some of the projects being supported by those funds
include: the development of a Continuing Medical Education curriculum
on hereditary breast and ovarian cancer that educates physicians about
how to identify, screen and manage high-risk patients; the
investigation of ways to improve follow-up care for ovarian cancer
patients given that so many experience disease recurrence; and the
examination of risk factors, treatment disparities and other factors
influencing survival rates to identify ways to improve patient outcomes
with existing tools and treatments.
With an allocation of $7.5 million in fiscal year 2015, the CDC
will be able to continue this important work, and expand a pilot
initiative that promotes educating women and providers about the BRCA
mutations, identifies women at high risk for developing breast/ovarian
cancer and ensures appropriate referral of these at risk women for
genetic counseling or testing. This pilot program is currently
operational in three States, but with increased funding, similar
programs can be established in additional States and communication
among women and their providers about genomic risk and testing can be
further encouraged.
Given the shared risk between ovarian and breast cancers for
individuals with BRCA mutations, it is imperative that we integrate
ovarian cancer risk assessment, education and genetic testing into
other CDC cancer-related programs, such as the EARLY Act and the
National Breast and Cervical Cancer Early Detection Programs. Combining
breast and ovarian cancer programs in this manner will leverage scarce
resources, better coordinate efforts between existing Federal programs,
create economies of scale and efficiencies with respect to CDC
education and awareness programs and advance complementary efforts to
reduce ovarian cancer related deaths.
cdc division of cancer prevention and control--johanna's law
Johanna's Law funds a CDC-led gynecologic cancer awareness
campaign, Inside Knowledge, which educates women and healthcare
providers about the signs and symptoms of gynecologic cancers. In
fiscal year 2014, CDC received $4.85 million for Johanna's Law
activities, which include supporting the ongoing creation and
dissemination of awareness campaign materials in English and Spanish,
and a series of print, radio and television PSAs featuring survivor
stories. In 2012, the campaign achieved one billion views of its PSAs
across media types.
With $5.5 million in fiscal year 2015, CDC will be able to continue
to raise awareness of the signs and symptoms of ovarian and other
gynecologic cancers, undertake a targeted outreach of its messages to
high risk women and expand its partnerships with external patient
advocacy, health professional and other stakeholder organizations to
leverage scarce resources and amplify their messages. Collaboration
with these organizations, such as the Alliance, would magnify the CDC's
efforts to raise awareness and help ensure that women, particularly
those known to be at a higher risk, seek the healthcare they need to
identify and treat gynecologic cancers early.
nci at nih
NCI and the NIH fund the majority of ovarian cancer research in the
United States and the world. On average, each year, NCI and NIH fund
more than $140 million in peer-reviewed research grants to researchers
at universities and small businesses across the United States. These
studies are generating insights into the origins of ovarian cancer and
disease progression that may lead to the development of early detection
tests and better treatments for ovarian cancer. For example, NIH and
NCI investments in basic research led to the understanding of a class
of enzymes called PARPs implicated in ovarian cancer. Pharmaceutical
companies have built upon these insights to develop PARP inhibitors, a
class of drugs holding great promise for ovarian cancer patients.
In addition to the basic research underlying future cures, NCI
supports clinical research necessary for translating those ideas into
treatments. NCI funding provides critical support to the ovarian cancer
Specialized Programs of Research Excellence (SPORE), which facilitate
collaborative research studies on the early detection and treatment of
ovarian cancer. The Roswell Park Cancer Institute and University of
Pittsburgh Cancer Institute Ovarian Cancer SPORE is working on reducing
morbidity and mortality of ovarian cancer through groundbreaking
translational research aimed at risk stratification, treatment, and
prevention of relapse. Currently, a phase I clinical trial is being
conducting on vaccines that induce anti-tumor immunity and several
other clinical trials are in development. NCI's clinical trials
enterprise plays an essential role in testing the safety and
effectiveness of potential treatments for ovarian cancer. Robust NCI
funding is critical to the continued excellence of the SPOREs.
Furthermore, NCI recently launched the National Clinical Trials
Network (NCTN), which consolidates and streamlines existing cooperative
clinical trial groups. One of these new groups, the NRG Oncology
Clinical Trial network, includes the Gynecologic Oncology Group (GOG),
whose trials have been responsible for several advances in ovarian
cancer research. Specifically, a GOG trial found that chemotherapy
followed by maintenance use of Avastin increased progression free
survival time of advanced ovarian cancer patients, when compared to
chemotherapy alone. By funding important trials such as this, GOG (and
now NRG) fills a clinical research gap left open by pharmaceutical
companies that do not often research maintenance therapies. Due to the
NCTN's critical importance in clinical trial design and implementation,
robust NCI funding is necessary to accomplish these and other important
tasks.
Robust investment in NCI of $5.26 billion, out of a total $32
billion for NIH in fiscal year 2015, is critical to ensuring the next
generation of discoveries that will improve the health and well-being
of women with--and at-risk for--ovarian cancer, as well as all
Americans.
* * *
The Alliance maintains a long-standing commitment to working with
Congress and other stakeholders to improve the survival rates for women
with ovarian cancer through increased research, education and
awareness. On behalf of our community of patients, caregivers and
survivors, we thank you for your consideration of our fiscal year 2015
requests and urge you to support the aforementioned Federal programs so
vital to conquering this horrible disease.
______
Prepared Statement of Parents of Dead Children
Can you please address a serious health epidemic that is affecting
families everywhere? There is a medical epidemic that no one in
Congress seems to want to address. That is heroin addiction and proper
ways to treat it. The government is spending way too much money in the
wrong places and the money should go for helpful and intensive
treatment, including a significant amount of time addressing mental
health treatment--again, something no one wants to talk about. Addicts
do not choose to be addicts, which seems to be the way the vast
majority of Americans like to think about it. There are mental health
issues that go untreated and lead to self-medication. Methadone Clinics
are a huge failure and have little to no oversight and certainly have
no statistics that provide meaningful data as to their success or
failure. The money poured into those places could be better utilized.
Also, more oversight of in patient treatment centers is desperately
needed--these are money making ventures and they say they treat for co-
occurring disorders (such as bi-polar), it is a joke. If a patient
meets one on one with a psychiatrist for half an hour every 2 weeks,
how does that help?
Read this article:The Problem with Methadone Clinics: They Are For-
Profit Businesses
Sine Nomine, Yahoo Contributor Network
Mar 30, 2007
Today, many Americans go to a methadone clinic. Some do it for
legitimate reasons, others do it just to get a high. The problem with
these methadone clinics are that they are for-profit organizations.
Many people do not realize that the methadone clinic is a business.
Businesses are open to make money. Here in lies the biggest problem
facing people who do go to these clinics. The nurses, the counselors,
and the doctors that are there to help patients are actually there to
keep patients coming back. Why would they want someone to quit coming
to the clinic? If everyone decided to quit using methadone then they
would be out of a job. I know many people who get up every morning and
make it to the methadone clinic. Some of these people have tried to
quit and they always go back. Most don't even last 2 days without their
methadone. These people have ended up trading one addiction for
another. That is what methadone is, a legal addiction. People can go
there everyday and get a legal high.
Besides that, regulations for methadone clinics are practically non
existent. You can fail a drug test there and not have to worry about
it. All that will happen to you is that they will make you come there
everyday to get your methadone. You won't be allowed to take any home
with you. What is even worse is they do not care if you fail a drug
test just as long as your back there the next day to get your next
dose. The government needs to step in and make some serious regulations
on this business.
As it stands, right now you can go to the methadone clinic for as
long as you need to. There is no turning you away just as long as you
can pay for your dose and to make that easier they will even let you
charge a day if you don't have the money. People go to the methadone
clinic for years even decades because they are addicted to the
methadone. Their bodies won't let them quit. They start suffering
withdraw symptoms within the first 48 hours. So back to the methadone
clinic they go. No one will help you detox if they know you are on
methadone. You have to go to a specialized institution to detox off
methadone.
The government can step in and ban the sell of prescription drugs,
ban the use of marijuana, they even tell you where you can and can't
smoke today. But what are they doing for the growing methadone problem?
Very little. More and more people are dying every day because of
methadone. But let me be clear it is not just the methadone that is
killing them. These people are mixing methadone with other drugs such
as Xanax, Valium, Percocet, OxyContin, etc. The drug tests done at
these methadone clinics show up these other drugs. Yet nothing is done
about the fact that these people are abusing other drugs that interact
with methadone causing a lethal combination. The government should step
in and implement a system for checking this so called business. A
system that would allow them to check the drug screens of each
individual. Those individuals that cannot pass three drug screens
should be eliminated from the program. The government should also make
it mandatory to drug test each individual at least twice a week. I also
believe that a set time limit for methadone maintenance should be
implemented. Every two weeks the patient should be made to come down a
minimum of two milligrams of methadone. This means that a patient
starting out at 50 mg will be completely off the methadone in a little
under a year. By implementing this system the government would decrease
the patients who abuse methadone and would help those who need the
methadone without making them methadone addicts.
Gina Haggerty, mother of a dead son who just wanted help and was
not going to a methadone clinic because he said they were a joke. The
deadline for submitting this testimony, May 23rd, would have been his
25th birthday.
______
Prepared Statement of the Parkinson's Action Network
Dear Chairman Harkin and Ranking Member Moran: The Parkinson's
Action Network (PAN) appreciates the opportunity to comment on the
fiscal year 2015 appropriations for the U.S. Department of Health and
Human Services. Our comments will focus on the importance of Federal
investment in biomedical research at the National Institutes of Health
(NIH) and the National Institute of Neurological Disorders and Stroke
(NINDS), which recently adopted a series of priority research
recommendations for Parkinson's disease. PAN supports at least $32
billion in funding for the NIH and an increase for NINDS to support the
research recommendations set forth by the NINDS planning strategy to
bring us closer to better treatments and a cure for Parkinson's
disease.
PAN is the unified voice of the Parkinson's community advocating
for better treatments and a cure. In partnership with other Parkinson's
organizations and our powerful grassroots network, we educate the
public and government leaders on better policies for research and
improved quality of life for the estimated 500,000 to 1.5 million
Americans living with Parkinson's, for whom there is no treatment
available that slows, reverses, or prevents progression.
As the second most common neurodegenerative condition after
Alzheimer's disease, Parkinson's disease is projected to grow
substantially over the next few decades as the size of the elderly
population grows and will have a direct impact on the healthcare system
and economy. A study published in Movement Disorders estimated that the
economic burden of Parkinson's disease is at least $14.4 billion a year
in the United States, and the prevalence of Parkinson's will more than
double by the year 2040.\1\ In addition, the study calculated an
additional $6.3 billion in indirect costs such as missed work or loss
of a job for the patient or family member who is helping with care,
long-distance travel to see a neurologist or movement disorder
specialist, as well as costs for home modifications, adult day care,
and personal care aides.
---------------------------------------------------------------------------
\1\ ``The Current and Projected Economic Burden of Parkinson's
Disease in the United States,'' Movement Disorders, Vol. 28, No. 3,
2013.
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A second study also published in Movement Disorders projected that
if Parkinson's progression were slowed by 50 percent, there would be a
35 percent reduction in excess costs, representing a dramatic reduction
in cost of care spread over a longer expected survival.\2\ Both studies
highlight the enormous economic implications of this devastating
disease, and make it abundantly clear that increased research funding
is a wise investment on the front end to help significantly lower or
eliminate costs on the back end.
---------------------------------------------------------------------------
\2\ ``An Economic Model of Parkinson's Disease: Implications for
Slowing Progression in the United States,'' Movement Disorders, Vol.
28, No. 3, 2013.
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NIH has the unique role of being at the forefront of medical
discovery in the United States. NIH supports research in all fifty
States, with more than 80 percent of the funding going to universities,
research institutions, and small businesses, which create thousands of
jobs and grow local economies. In 2012, this amounted to over 402,000
jobs nationwide and $57.8 billion in economic activity. Perhaps even
more important than their economic contributions is the practical
impact NIH grants have in identifying and developing a better
understanding of and treatments for countless complex diseases and
disorders.
There is currently a concerted effort at NIH to better target areas
of unmet medical need, including Parkinson's research. In January 2014,
NINDS approved a list of 31 priority research recommendations specific
to Parkinson's that highlight areas in which NINDS and the broader
field should direct its resources to achieve the greatest impact in
addressing treatments and the underlying causes of the disease. These
recommendations were the result of an intensive planning process that
brought together clinicians, researchers, and the patient community to
determine the areas of greatest need to reframe how we approach the
disease. We applaud NINDS for their leadership in this effort, which
represents an unparalleled opportunity to coordinate critical
initiatives to help unlock the mysteries of Parkinson's--but its
success is dependent upon strengthening funding at NIH and NINDS to
ensure that sufficient capacity and resources are available.
Unfortunately, due to ongoing fiscal constraints, including
sequestration, the NIH research budget has not kept pace with inflation
or the growing needs of an aging population and the overall public
health. Sequestration alone cut over $1.55 billion from NIH in fiscal
year 2013, which is roughly equivalent to the entire budget for NINDS.
NIH, the largest funder of Parkinson's research in the world, was also
forced to reduce its Parkinson's-related research from a high of $154
million in fiscal year 2012 to $135 million in fiscal year 2013, a 12
percent decrease. Across the country, many institutions have felt the
burden of these cuts, receiving smaller grants or no grants at all. As
NIH continues to find high-priority areas to fund in order to advance
Parkinson's research, we should be increasing support and not applying
cuts that could possibly delay years of progress toward a cure for
Parkinson's and other diseases.
Despite some greater certainty in the current appropriations cycle
because of the budget agreement passed in December 2013, there is still
grave concern over the implications for medical research long-term. Dr.
Francis Collins, director of NIH, has even noted that ``without
sustained investment, many high-priority efforts would move at a
substantially slower pace, and years of effectively flat funding for
biomedical research have left scientists facing the lowest chances in
history of having their research funded by NIH.'' \3\ Because of this
trend, there is also the fear that the next generation of scientists
will leave the United States or be reluctant to enter the field of
neurological research at all because of the uncertainty in financial
support they see and feel here at home. Innovation and new
possibilities for medical research are at our fingertips, and we must
be sure that we have the resources in place to fully recognize and
cultivate their potential.
---------------------------------------------------------------------------
\3\ ``Investing in the Nation's Health,'' Dr. Francis Collins. The
Washington Post. Opinions. December 24, 2013.
---------------------------------------------------------------------------
We recognize that due to spending caps put into place by the 2013
budget agreement, the President's fiscal year 2015 budget proposal only
requests a modest increase for NIH and many other important programs.
But, we also understand that the final decision on how these funds
should be allocated within those caps is the responsibility of
Congress--and we look to you for your leadership and support. PAN urges
the Subcommittee to prioritize biomedical research funding by
supporting at least $32 billion for the NIH overall and increasing
funding for NINDS to advance critical priorities designed to
fundamentally change our understanding of Parkinson's disease. We look
forward to working with the Subcommittee as the fiscal year 2015
appropriations process moves forward.
______
Prepared Statement of the Pew Children's Dental Campaign
On behalf of the Pew Children's Dental Campaign, thank you for the
opportunity to submit testimony regarding appropriations for fiscal
year 2015. We appreciate the subcommittee's recognition of oral health
as a key aspect of overall health and its continued support of programs
that expand access to preventive and restorative services through the
Health Resources and Services Administration (HRSA) and the Centers for
Disease Control and Prevention (CDC).
The Pew Children's Dental Campaign works at the State and national
levels to ensure that more children receive dental care and benefit
from evidence-based policies, such as community water fluoridation,
dental sealant programs, and expansion of the dental workforce. Since
it was established in 2008, our initiative has produced numerous
reports evaluating access to care across the 50 States and the District
of Columbia, and while we have made significant progress in advancing
reforms nationally and in the States, there is still much to be done on
this important issue.
Tooth decay affects nearly 60 percent of the Nation's children,
and, unsurprisingly, its consequences are concentrated
disproportionately among low-income children.\1\ Dental disease is the
most common chronic disease among children in the U.S.--five times more
prevalent than asthma, and in a single year, U.S. students may miss as
many as 51 million hours of school due to dental health problems.\2\ It
causes pain, hampers school performance, and if left untreated can lead
to tooth loss and abscesses that spread infection to the blood and
brain.\3\
---------------------------------------------------------------------------
\1\ U.S. Department of Health and Human Services, Oral Health in
America: A Report of the Surgeon General, DHHS, Rockville, MD, 2000.
\2\ Ibid.
\3\ Ibid.
---------------------------------------------------------------------------
Lack of access to preventive services and oral healthcare also
imposes a huge cost on States. In 2011, preventable dental conditions
were the primary reason for 857, 712 emergency room (ER) visits in the
U.S.\4\ In 2010, Florida spent more than $88 million on more than
115,000 hospital ER visits for dental problems and in 2007, 60,000
dental visits to ERs cost the State of Georgia more than $23
million.\5,6\ Dental problems can also impact the workforce, causing an
estimated 164 million hours of lost work time each year, and can
inhibit a person's ability to find a job.\7\ Additionally, a 2008 study
of the armed forces found that 52 percent of new recruits were found to
be Class 3 in ``dental readiness,'' meaning they had oral health
problems that needed urgent attention and would delay overseas
deployment.\8\
---------------------------------------------------------------------------
\4\ HCUPnet, Healthcare Cost and Utilization Project, ``Information
on ED visits from the HCUP Nationwide Emergency Department Sample
(NEDS),'' Agency for Healthcare Research and Quality, Rockville, MD.
http://hcupnet.ahrq.gov/
\5\ ``315 Patients a Day Seek Dental Treatment in Florida's
Hospital Emergency Rooms,'' a news release by the Florida Public Health
Institute, (December 15, 2011).
\6\ Andy Miller, ``Fight over Georgia dental rules flares again,''
Georgia Health News, September 7, 2011, http://
www.georgiahealthnews.com/2011/09/fight-dental-rules-flares/.
\7\ U.S. Department of Health and Human Services, Oral Health in
America: A Report of the Surgeon General, DHHS, Rockville, MD, 2000.
\8\ T. M. Leiendecker, G. C. Martin et al., ``2008 DOD Recruit Oral
Health Survey: A Report on Clinical Findings and Treatment Need,'' Tri-
Service Center for Oral Health Studies (2008), 1.
---------------------------------------------------------------------------
Given the enormous impact of oral health on overall health and the
associated social and economic consequences, we respectfully request
that the subcommittee consider the following appropriations requests
for programs that aim to expand access to care and preventive services
for those most in need.
Focusing on prevention
With support from the CDC Division of Oral Health, States can
better promote oral health and efficiently administer scarce resources,
monitor oral health status and problems, and conduct and evaluate
prevention programs through cooperative agreements. This funding is
critical to a State's ability to prevent problems before they occur,
rather than treating them when they are painful and expensive. The
cooperative agreement program also supports State community water
fluoridation programs and school-based dental sealant programs, and
while funding for this program has been authorized for all 50 States,
the Division is currently only able to support 21 States: Colorado,
Connecticut, Georgia, Hawaii, Idaho, Iowa, Kansas, Louisiana, Maryland,
Michigan, Minnesota, Mississippi, New Hampshire, New York, North
Dakota, Rhode Island, South Carolina, Vermont, Virginia, West Virginia,
and Wisconsin.
Research shows that community water fluoridation offers one of the
greatest returns on investment of any preventive healthcare strategy.
For most cities, every $1 invested in water fluoridation saves $38 in
dental treatment costs.\9\ CDC estimates that fluoridated water saves
more than $4.6 billion annually in dental costs in the United
States,\10\ and even more could be saved by expanding coverage to some
of the 70 million people who still do not have it.\11\ Dental sealants
are also cost-effective; school-based programs can efficiently prevent
60 percent of decay in the permanent teeth most likely to become
decayed during childhood.\12\ We recommend a funding level sufficient
to enable all States and the District of Columbia to receive the
critical CDC prevention funds, starting with an increase for the coming
fiscal year to begin moving toward full funding.
---------------------------------------------------------------------------
\9\ Centers for Disease Control and Prevention, ``Cost Savings of
Community Water Fluoridation,'' Fact Sheet, Accessed March 27, 2014:
http://www.cdc.gov/fluoridation/factsheets/cost.htm
\10\ Centers for Disease Control and Prevention, ``Preventing
Dental Caries with Community Programs,'' Fact Sheet, Accessed March 27,
2014: http://www.cdc.gov/oralhealth/publications/factsheets/
dental_caries.htm
\11\ Centers for Disease Control and Prevention, ``2012 Water
Fluoridation Statistics,'' Data and Statistics, Accessed March 27,
2014: http://www.cdc.gov/fluoridation/statistics/2012stats.htm
\12\ Truman, B. I., Gooch, B. F., Sulemana, I., Gift, H. C.,
Horowitz, A. M., Evans, C. A., et al. (2002). Reviews of evidence on
interventions to prevent dental caries, oral and pharyngeal cancers,
and sports-related craniofacial injuries. American Journal of
Preventive Medicine, 23(1 Suppl.), 21--54.
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Funding request for fiscal year 2015: $19 million for the CDC Division
of Oral Health to expand cooperative agreements to additional
States
Addressing the dental access crisis
Pew's 2013 brief, In Search of Dental Care, found that roughly 45
million Americans live in dental professional shortage areas, regions
that have a scarcity of dentists relative to the population.\13\
Additionally, in 2011, more than 14 million children enrolled in
Medicaid did not receive any dental service, in part due to the low
numbers of dentist participation in the Medicaid program.\14\ The
supply of dentists nationally is also likely to shrink in the coming
years. The American Dental Association projects that despite the
addition of new dental schools and possible increase in graduates,
between 2010 and 2030 the ratio of dentists to Americans will continue
to fall due to high numbers of dentists approaching retirement age.\15\
---------------------------------------------------------------------------
\13\ The Pew Charitable Trusts, ``In Search of Dental Care,'' June
2013, http://www.pewstates.org/uploadedFiles/PCS_Assets/2013/
In_search_of_dental_care.pdf
\14\ This figure counts children ages 1 to 18 eligible for the
Early and Periodic Screening, Diagnostic and Treatment Benefit. See
U.S. Department of Health and Human Services, Centers for Medicare and
Medicaid Services, Annual EPSDT Participation Report, Form CMS-416
(National) fiscal year: 2011, April 1, 2013. Analysis by The Pew
Charitable Trusts; U.S. Department of Health and Human Services,
Centers for Medicare and Medicaid Services, Early and Periodic
Screening, Detection and Treatment Web page (accessed May 24, 2013),
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/
Benefits/Early-Periodic-Screening-Diagnosis-and- Treatment.html.
\15\ American Dental Association, Health Policy Resources Center,
2011 American Dental Association Workforce Model: 2009-2030 (Chicago:
American Dental Association, 2011), 11.
---------------------------------------------------------------------------
Many States are expanding scope of practice laws to enable a
variety of dental care providers to expand access to care to the
underserved, such as dental therapists in Minnesota and Alaska tribal
lands, public health hygienists in Kentucky, Maryland, and New
Hampshire, and community dental health coordinators in Arizona,
California, Montana, New Mexico, Oklahoma, and Wisconsin. A Federal
demonstration grant program authorized in 2010 but currently unfunded
would provide training institutions, community health centers, public
hospitals, and other organizations with funding to train these types of
providers, all in accordance with State scope of practice laws, and
evaluate their impact on access to care.\16\ Also eligible for funding
through this demonstration are programs such as one in California that
uses telehealth services to bring care to patients in Head Start
centers and nursing homes \17\ and ER diversion programs that link
public hospitals to federally qualified health centers.\18\
---------------------------------------------------------------------------
\16\ Patient Protection and Affordable Care Act of 2010, Public Law
No. 111-148, sec. 5304, 124 Stat. 119, 621-622 (2010).
\17\ Virtual Dental Home Demonstration Project, Arthur A. Dugoni
School of Dentistry, University of the Pacific: http://
www.dental.pacific.edu/Community_Involvement/
Pacific_Center_for_Special_Care--(PCSC)/Innovations_Center/
Virtual_Dental_Home_Demonstration_Project. html.
\18\ Centers for Medicare and Medicaid Services, ``Emergency Room
Diversion Grant Program,'' 2008- 2011, http://www.medicaid.gov/
Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Grant-
Programs/ER-Diversion-Grants.html.
---------------------------------------------------------------------------
Pilot efforts to assess how new dental providers can increase
access to care are being developed in Oregon, Michigan, Connecticut and
Hawaii, and Maine, Kansas, New Mexico, Ohio, and Washington are among
the States considering legislation to authorize dental therapists.
These providers and programs can increase access at a lower cost to
States, and numerous studies have reaffirmed the quality of the
services being provided.\19\ These evaluations would not only benefit
those States that have authorized alternative providers, but would also
provide information to inform policies in the many other States that
are struggling to find answers to the challenge of expanding access to
the underserved.
---------------------------------------------------------------------------
\19\ David A. Nash et al., A Review of the Global Literature on
Dental Therapists, April 2012, W.K. Kellogg Foundation, http://
www.wkkf.org/knowledge-center/resources/2012/04/nash-dental-therapist-
literaturereview.aspx.
---------------------------------------------------------------------------
HRSA funding request for fiscal year 2015:
--Removal of the current funding block on existing funding for the
Alternative Dental Health Care Provider Demonstration Grants,
Section 340G-1 of the Public Health Service Act, and an
appropriation of $10 million to initiate the program
--$32 million for Title VII program grants to expand and educate the
dental workforce
By making targeted Federal investments in effective policy
approaches, the subcommittee can enable States to sustain programs that
prevent the pain, missed school hours and long-term health and economic
consequences of untreated dental disease. A handful of States are
leading the way, but all States can and must do more to ensure access
to dental care for those who need it most. Thank you for your
consideration of this testimony.
[This statement was submitted by Shelly Gehshan, Director, Pew
Children's Dental Campaign.]
______
Prepared Statement of the Physician Assistant Education Association
On behalf of the 187 accredited physician assistant (PA) education
programs in the United States, the Physician Assistant Education
Association (PAEA) is pleased to submit these comments on the fiscal
year 2015 appropriations for PA education programs that are authorized
through Title VII of the Public Health Service Act. PAEA supports
funding of at least $280 million in fiscal year 2015 for the health
professions education programs authorized under Title VII of the Public
Health Service Act and administered through the Health Resources and
Services Administration (HRSA). We also request $12 million of that
funding support PA programs operating across the country. This is the
only designated source of Federal funding for PA education and is
crucial to the U.S. PA education system's ability to meet the demand
for education and to continue to produce highly skilled physician
assistants ready to enter the healthcare workforce in an average of 26
months. The way that PAs are educated in America--the caliber of our
institutions and the expertise of our educators--is the gold-standard
throughout the world and that distinction must be maintained in this
period of unprecedented patient need and rapid growth within the PA
profession.
Need for Increased Federal Funding
The unmet need for primary care services in the United States is
well documented, and only expected to grow as Baby Boomers age and the
Affordable Care Act is fully implemented. The very parameters of access
and healthcare quality are rapidly evolving. Yet the one constant in
our healthcare system remains the need for qualified healthcare
providers in numbers sufficient to meet demand, and primary care has
been clearly identified as the critical entry point into the healthcare
system where that access must be guaranteed. The PA profession was
created specifically to address a shortage of primary care physicians
almost fifty years ago, and today's PAs stand ready to help address the
challenges our Nation faces in primary care. The effectiveness of
physician assistants is well-documented by studies showing better
patient access, especially for Medicaid patients, high patient
satisfaction, more frequent patient education, and healthcare outcomes
similar to physicians. Importantly, PAs could play an even larger role
in high-quality, cost-effective care if offered appropriate financial
support and through innovations in the PA education system.
Like physicians, the PA profession also faces a shortage of
graduates that will hinder its ability to help fully address the
primary care issue in the United States. Without new solutions, at the
current output of approximately 7000 graduates from PA programs per
year, these shortages will persist, particularly in the rural and
underserved communities where care is needed the most. Title VII is the
only funding source that provides direct support for PA programs and
plays a crucial role in developing and supporting the education
system's ability to produce the next generation of these advanced
practice clinicians.
Background on the Profession
Since the 1960s, PAs have consistently demonstrated they are
effective partners in healthcare, readily adaptable to the needs of an
ever-changing delivery system. Physician assistants are licensed health
professionals with advanced education in general medicine that practice
medicine as members of the healthcare team. They provide a broad range
of medical and therapeutic services to diverse populations in rural and
urban settings, including prescriptive authority in all 50 States, the
District of Columbia, and Guam. PAs practice medicine to the extent
allowed by law and within the physician's scope of practice and their
combination of medical training, advanced education, and hands-on
experience allows PAs to practice with significant autonomy, and in
rural and other medically underserved areas where they are often the
only full-time medical provider. The profession is well established,
yet nimble enough to embrace new models of care, adopt innovative
approaches to training and education, and adapt to health system
challenges. The PA practice model is, by design, a team-based approach
to patient-centered care where the PA works in tandem with a physician
and other health professionals. This PA practice approach to quality
care is uniquely aligned with the patient-centered, collaborative,
interprofessional and outcomes-based care models transforming the U.S.
healthcare system.
PA Education: The Pipeline for Physician Assistants
There are currently 187 accredited PA education programs in the
United States--a 23 percent increase over the past 5 years; together
these programs graduate over 7,000 PA students each year. PAs are
educated as generalists in medicine and that training gives them the
flexibility to practice in more than 60 medical and surgical
specialties. More than one third of PA program graduates are working in
a primary care specialty.
The average PA education program is 26 months in length and
includes one didactic year in the classroom, and another year devoted
to clinical rotations. Most curricula include 340 hours of basic
sciences and nearly 2,000 hours of clinical training, second only to
physicians in time spent in clinical study.
As of today, approximately 65 new PA programs are in the pipeline
at various stages of development and moving toward accredited status.
The growth rate in the applicant pool is even more pronounced. Since
its inception in 2001 through the most recent application cycle, the
Centralized Application Service (CASPA) used by most programs grew from
4,669 applicants to over 20,000. As of March 2014, there were 19,968
applicants to PA education programs, a 36 percent increase in CASPA
applicants over the past 5 years alone.
The PA profession is expected to continue to grow as a result of
the projected shortages of physicians and other healthcare
professionals, the growing demand for care driven by an aging
population, and the continuing strong PA applicant pool. Accordingly,
The Bureau of Labor Statistics projects a 39 percent increase in the
number of PA jobs between 2008 and 2018. With its relatively short
initial training time and the flexibility of generalist-trained PAs,
the PA profession is well-positioned to help fill projected shortages
in the numbers of healthcare professionals--if appropriate resources
are available to support the education system behind them.
areas of acute need
Faculty Shortages
Faculty development is one of the profession's critical needs and
educators are an often overlooked element to developing an adequate
primary care workforce. Nearly half of PA program faculty are 50 years
or older and the PA teaching profession faces large numbers of
retirements in the next 10-15 years. An interest in education must be
developed early in the educational process to ensure a continuous
stream of educators, and to do so, we must alleviate the significant
loan burdens that prevent many physician assistants from entering
academia. In order to attract the most highly qualified faculty, PA
education programs must have the resources to help clinicians
transition into education, including curriculum development, teaching
methods, and laboratory instruction. Most educators come from clinical
practice and these non-clinical professional skills are essential to a
successful transition from clinical practice to a classroom setting.
Without Federal support, we will face an impending shortage of
educators who are prepared for and committed to the critical teaching
role that will ensure the next generation of skilled practitioners.
Clinical Site Shortages
Outside of the classroom, PA education faces additional challenges
in meeting demand. A lack of clinical sites for PA education is
hampering PA programs' ability to produce PAs at the pace needed to
meet the demand for primary care in the U.S. This shortage is caused by
two main factors: a shortage of medical professionals willing to teach
students as they are cycling through their clinical rotations
(preceptors), and a lack of sites with the physical space to teach.
This phenomenon is experienced throughout the health professions,
and is particularly acute in primary care. It has created unintentional
competition for clinical sites and preceptors within and among PAs,
physicians and advance practice nurses. Federal funding can help
incentivize practicing clinicians to both offer their time as
preceptors, and volunteer their clinical operations as training grounds
for PAs and other health professionals to train together and directly
interact with patients as a team. PAEA believes that interprofessional
clinical training and practice are necessary for optimum patient care
and will be a defining model of healthcare in the U.S. in the 21st
century. We can only make that a reality if we begin to build a
sufficient network of health professionals who are willing to teach the
next generation of primary care professionals--that approach will
benefit PAs as well as the future physicians, nurses and other
clinicians that comprise the full primary care team.
Enhancing Diversity
Workforce diversity, and practice in underserved areas are key
priorities identified by HRSA and are consistent with those of PAEA. It
is increasingly important for patient care quality that the health
workforce better represents America's changing demographics, as well as
addresses the issues of disparities in healthcare. PA programs have
been committed to attracting students from underrepresented minority
groups and disadvantaged backgrounds into the profession, including
veterans who have served our country and desire to transition to
civilian health professions. Studies have found that health
professionals from underserved areas are three to five times more
likely to return to underserved areas to provide care, and PA programs
are looking for unique ways to recruit diverse individuals into the
profession, and sustain them as leaders in the education field. If we
can provide resources to schools that are particularly poised to
improve their diversity recruitment efforts and replicate or create
best practices including transition programs for our veterans, we can
begin to address this systemic need.
In order to leverage the efforts of PA programs through Title VII
funding to increase workforce diversity in the PA profession, PAEA also
supports the restoration of funding for the Health Careers Opportunity
Program (HCOP), and increased funding for the Scholarships for
Disadvantaged Students and National Health Service Corps. Historically,
access to higher education has been constrained for individuals from
disadvantaged backgrounds. These programs help to provide a clear path
for students who might not otherwise consider a physician assistant
career.
Title VII Funding
Title VII funding fills a critical need for curriculum development,
faculty development, clinical site expansion and diversification of the
primary care workforce--areas that if appropriately supported can help
ensure the PA profession realizes its full promise in the U.S.
healthcare system. These funds enhance clinical training and education,
assist PA programs with recruiting applicants from minority and
disadvantaged backgrounds, and enable innovative programs that focus on
educating a culturally competent workforce. Title VII funding increases
the likelihood that PA students will practice in medically underserved
communities with health professional shortages. The absence of this
funding would result in the loss of care to patients with the most
urgent need for access to care.
Title VII support for PA programs was strengthened in 2010 when
Congress enacted a 15 percent allocation in the Appropriations process
specifically for PA programs working to address the health provider
shortage. This funding has enhanced capabilities to train a growing PA
workforce, creatively expand care to the underserved, and develop a
more diverse PA workforce:
--One Texas program has used its PA training grant to support the
program at a distant site in an underserved area. This grant
provides assistance to the program for recruiting, educating,
and training PA students in the largely Hispanic South Texas
and mid-Texas/Mexico border areas and supports new faculty
development.
--A Utah program has used its PA training grant to promote
interprofessional teams. The grant allowed the program to
optimize its relationship with three service-learning partners,
develop new partnerships with three service-learning sites, and
create a model geriatric curriculum that includes didactic and
clinical education.
--An Alabama program used its PA training grant to update and expand
the current health behavior educational curriculum and HIV/STD
training. They were also able to include PA students from other
programs who were interested in rural, primary care medicine
for a four-week comprehensive educational program in HIV
disease diagnosis and management.
Recommendations on fiscal year 2015 Funding
The Physician Assistant Education Association requests the
Appropriations Committee's support in funding for Title VII health
professions programs at a minimum of $280 million for fiscal year
2015.This level of funding is crucial to support the Nation's ability
to produce and maintain highly skilled primary care practitioners,
particularly those from diverse backgrounds and the military who will
practice in medically underserved areas and serve vulnerable
populations. We also ask for the continuation of the 15 percent
allocation for PA education programs in the Primary Care cluster as
mandated in the Affordable Care Act. The Accreditation Review
Commission on Education for the Physician Assistant estimates that an
additional 75 programs will be added by 2018. Therefore, we request an
increase in funding to $12 million which will allow sufficient funding
for the expanding number of PA programs expected to begin enrolling
students during the next four to 5 years.
We thank the members of the subcommittee for their support of the
health professions and look forward to your continued commitment to
finding solutions to the Nation's health workforce shortage. We
appreciate the opportunity to present the Physician Assistant Education
Association's fiscal year 2015 funding recommendation.
[This statement was submitted by Anthony Miller, M.Ed., PA-C Chief
Policy and Research Officer.]
______
Prepared Statement of the Population Association of America and
Association of Population Centers
Introduction
Thank you, Mr. Chairman Harkin, Ranking Member Moran, and other
distinguished members of the Subcommittee, for this opportunity to
express support for the National Institutes of Health (NIH), National
Center for Health Statistics (NCHS), and Bureau of Labor Statistics
(BLS). These agencies are important to the members of the Population
Association of America (PAA) and Association of Population Centers
(APC) because they provide direct and indirect support to population
scientists and the field of population, or demographic, research
overall. In fiscal year 2015, we urge the Subcommittee to adopt the
following funding recommendations: NIH, $32 billion, consistent with
the level recommended by the Ad Hoc Group for Medical Research; NCHS,
$182 million, consistent with the Administration's request; and BLS,
$610 million, consistent with the Administration's request, at a
minimum.
The PAA and APC are two affiliated organizations that together
represent over 3,000 social and behavioral scientists and almost 40
population research centers nationwide that conduct research on the
implications of population change. Our members, which include
demographers, economists, sociologists, and statisticians, conduct
scientific research, analyze changing demographic and socio-economic
trends, develop policy recommendations, and train undergraduate and
graduate students. Their research expertise covers a wide range of
issues, including adolescent health and development, aging, health
disparities, immigration and migration, marriage and divorce,
education, social networks, housing, retirement, and labor.
National Institutes of Health
Demography is the study of populations and how or why they change.
A key component of the NIH mission is to support biomedical, social,
and behavioral research that will improve the health of our population.
The health of our population is fundamentally intertwined with the
demography of our population. Recognizing the connection between health
and demography, NIH supports extramural population research programs
primarily through the National Institute on Aging (NIA) and the
National Institute of Child Health and Human Development (NICHD).
National Institute on Aging
To inform the implications of our rapidly aging population,
policymakers need objective, reliable data about the antecedents and
impact of changing social, demographic, economic, health and well-being
characteristics of the older population. The NIA Division of Behavioral
and Social Research (BSR) is the primary source of Federal support for
basic research on these topics.
In addition to supporting an impressive research portfolio that
includes the prestigious Centers on the Demography and Economics of
Aging, the NIA BSR Division also supports several large surveys that
produce accessible data. These surveys include the National Health and
Aging Trends Study (NHATS), which has enrolled 8,000 Medicare
beneficiaries with the goal of studying late-life disability trends and
dynamics. The study also includes a supplement to examine informal
caregivers and their impact on the utilization of long-term care by
people with chronic disabilities. Another NIA survey, the Health and
Retirement Study (HRS), provides unique information about economic
transitions in work, income, and wealth, allowing scientists to study
how the domains of family, economic resources, and health interact. The
HRS has collected data every 2 years since 1992, including most
recently, biomarkers, from a representative sample of more than 26,000
Americans over the age of 50. These data are accessible to researchers
worldwide and have informed numerous scientific findings. For example,
in 2013, researchers using the HRS published a study in the New England
Journal of Medicine, concluding that the cost of providing dementia
care is comparable to, if not greater than, those for heath disease and
cancer.
Eunice Kennedy Shriver National Institute of Child Health and Human
Development
Since 1968, NICHD has supported research on population processes
and change. This research is housed in the Institute's Population
Dynamics Branch, which supports research and training in demography,
reproductive health, and population health and funds major national
studies that track the health and well-being of children and their
families from childhood through adulthood. These studies include
Fragile Families and Child Well-Being, the first scientific study to
track the health and development of children born to unmarried parents,
and the National Longitudinal Study of Adolescent Health (Add Health),
tracing the effects of childhood and adolescent exposures on later
health.
One of the most important population research programs that the
NICHD supports is the Population Dynamics Centers Research
Infrastructure Program. This program promotes innovation, supports
interdisciplinary research, translates scientific findings into
practice, and develops the next generation of population scientists. In
addition, the centers provide incentives to reduce the costs and
increase the efficiency of research by streamlining and consolidating
research infrastructure. The population research centers generate and
facilitate significant scientific research findings as well. For
example, in March 2014, researchers at Johns Hopkins University
published findings in JAMA, concluding that opening or expanding
casinos on California tribal lands reduces poverty and the obesity rate
of children by almost 3 percent.
National Center for Health Statistics
The National Center for Health Statistics (NCHS) is the Nation's
principal statistical agency. Most notably, NCHS funds and manages the
National Vital Statistics System (NVSS), which contracts with the
States to collect birth and death certificate information, and funds a
number of complex large surveys, such as National Survey of Family
Growth and National Health Interview Survey, which are an invaluable
resource for population scientists. The Subcommittee's support of NCHS
in recent years has enabled it to make significant progress toward
modernizing the NVSS and expediting the release of these data to the
user community. Yet, much work is still needed to fully modernize the
NVSS and to support necessary expansions to the agency's core surveys
so that these data can effectively assess Americans' health.
Bureau of Labor Statistics
The Bureau of Labor Statistics (BLS) produces essential economic
information for public and private decisionmaking. Its data are used
extensively by population scientists who study and evaluate labor and
related economic policies and programs. Given the importance and unique
nature of BLS data, we urge the Subcommittee to support the
Administration's request, $610 million, at a minimum, but to consider
increasing its funding to $631 million. This additional funding is
necessary to restore the agency's purchasing power back to fiscal year
2010 levels and specifically to restore recent program cuts.
Thank you for considering the importance of these agencies under
your jurisdiction that benefit the population sciences.
[This statement was submitted by Mary Jo Hoeksema, Director,
Government Affairs Population Association of America/Association of
Population Centers.]
______
Prepared Statement of Prevent Blindness
funding request overview
Prevent Blindness appreciates the opportunity to submit written
testimony for the record regarding fiscal year 2015 funding for vision
and eye health related programs. As the Nation's leading non-profit,
voluntary health organization dedicated to preventing blindness and
preserving sight, Prevent Blindness maintains a long-standing
commitment to working with policymakers at all levels of government,
organizations and individuals in the eye care and vision loss
community, and other interested stakeholders to develop, advance, and
implement policies and programs that prevent blindness and preserve
sight. Prevent Blindness respectfully requests that the Subcommittee
provide the following allocations in fiscal year 2015 to help promote
eye health and prevent eye disease and vision loss:
--Provide at least $1,000,000 to strengthen the Vision Health
Initiative (visual screening education) at the Centers for
Disease Control and Prevention (CDC).
--Provide at least $3,319,000 to continue the Glaucoma Project at the
CDC.
--Support the Maternal and Child Health Bureau's (MCHB) National
Center for Children's Vision and Eye Health.
--Provide at least $639 million in to sustain programs under the
Maternal and Child Health (MCH) Block Grant.
--Provide at least $730 million to the National Eye Institute (NEI).
introduction and overview
Vision-related conditions affect people across the lifespan. Good
vision is an integral component to health and well-being, affects
virtually all activities of daily living, and impacts individuals
physically, emotionally, socially, and financially. Loss of vision can
have a devastating impact on individuals and their families. An
estimated 80 million Americans have a potentially blinding eye disease,
three million have low vision, more than one million are legally blind,
and 200,000 are more severely visually blind. Vision impairment in
children is a common condition that affects five to 10 percent of
preschool age children, and is a leading cause of impaired health in
childhood. Recent research showed that the economic burden of vision
loss and eye disorders is $139 billion each year, $47.4 billion of
which is Federal spending. Alarmingly, while half of all blindness can
be prevented through education, early detection, and treatment, the NEI
reports that ``the number of Americans with age-related eye disease and
the vision impairment that results is expected to double within the
next three decades.'' \1\
---------------------------------------------------------------------------
\1\ ``Vision Problems in the U.S.: Prevalence of Adult Vision
Impairment and Age-Related Eye Disease in America,'' Prevent Blindness
America and the National Eye Institute, 2008.
---------------------------------------------------------------------------
To curtail the increasing incidence of vision loss in America, and
its accompanying economic burden, Prevent Blindness advocates sustained
and meaningful Federal funding for programs that promote eye health and
prevent eye disease, vision loss, and blindness; needed services and
increased access to vision screening; and vision and eye disease
research. In a time of significant fiscal constraints, we recognize the
challenges facing the Subcommittee and urge you to consider the
ramifications of decreased investment in vision and eye health. Vision
loss is often preventable, but without continued efforts to better
understand eye conditions, and their treatment, through research, to
develop the public health systems and infrastructure to disseminate and
implement good science and prevention strategies, and to protect
children's vision, millions of Americans face the loss of independence,
loss of health, and the loss of their livelihoods, all because of the
loss of their vision.
vision and eye health at the cdc: helping to save sight and save money
The CDC serves a critical role in promoting vision and eye health.
Since 2003, the CDC and Prevent Blindness have collaborated with other
partners to create a more effective public health approach to vision
loss prevention and eye health promotion. The CDC works to promote eye
health and prevent vision loss; improve the health and lives of people
living with vision loss by preventing complications, disabilities, and
burden; reduce vision and eye health related disparities; and integrate
vision health with other public health strategies. However, severely
constrained financial resources have limited the CDC's ability to take
the work of the Vision Health Initiative (VHI) to the next level.
Prevent Blindness requests at least $1,000,000 in fiscal year 2015
to strengthen vision and eye health efforts of the CDC. This funding
level would allow the VHI to increase vision impairment and eye disease
surveillance efforts, apply previous CDC vision and eye health research
findings to develop effective prevention and early detection
interventions, and begin to incorporate vision and eye health promotion
activities into State and national public health chronic disease
initiatives, with an initial focus on early detection of diabetic
retinopathy
Improving Access to Eye Care for those at High Risk for Glaucoma
An estimated 2.2 million people are affected by glaucoma. A disease
of the aging eye, risk for glaucoma increases with age, especially
among black, Hispanic/Latinos, and Asians. Once vision is lost to
glaucoma, it cannot be restored, but with early diagnosis and
appropriate treatment, it is possible to slow disease progression and
save the remaining sight. Detection and management of glaucoma are
challenged by difficulties in reaching high-risk populations and by the
lack of simple, cost-effective screening plans.
Prevent Blindness requests at least $3,319,000 in fiscal year 2015
to continue the work of the Glaucoma Project to improve glaucoma
screening, referral, and treatment. The program is intended to reach
those populations experiencing the greatest disparity in access to
glaucoma care through an integrated collaboration among private and
public organizations.
investing in the vision of our nation's most valuable resource--
children
While the risk of eye disease increases after the age of 40, eye
and vision problems in children are of equal concern. The visual system
in children younger than 8 years old is in a critical developmental
stage. Unidentified and untreated vision problems can lead to permanent
and irreversible visual loss and/or cause problems socially,
academically, and developmentally in this critical time of a child's
life. Currently, only one in three children receive eye care services
before the age of six.[1] Requirements for preventive eye care/vision
screenings prior to or during the school years vary broadly from State
to State. Many States have no standards and those with standards
present with little consistency regarding type, frequency, and referral
or follow-up requirement protocol.[i] Inclusion of vision screenings
with a comprehensive approach to follow up treatment and an integrated
approach to data collection as a part of the required health component
for grant recipients will help to change disparities in vision and eye
health for our Nation's children.
In 2009, the MCHB established the National Center for Children's
Vision and Eye Health (the Center), a national vision health
collaborative effort aimed at developing the public health
infrastructure necessary to promote eye health and ensure access to a
continuum of eye care for young children.
The Center is guided by an Advisory Committee comprised of the
Nation's leaders in children's vision and public health to implement
national guidelines for quality improvement strategies, vision
screening and developing a continuum of children's vision and eye
health. With this support the Center, will continue to: (1) provide
national leadership in dissemination of best practices, infrastructure
development, professional education, and national vision screening
guidelines that ensure a continuum of vision and eye healthcare for
children; (2) advance State-based performance improvement systems,
screening guidelines, and mechanisms for uniform data collection and
reporting; and (3) provide technical assistance to States in the
implementation of strategies for vision screening, establishing quality
improvement measures, and improving mechanisms for surveillance.
Prevent Blindness also requests at least $639 million in fiscal
year 2015 to sustain programs under the MCH Block Grant. The MCH Block
Grant enables States to expand critical healthcare services to millions
of pregnant women, infants and children, including those with special
healthcare needs. In addition to direct services, the MCH Block Grant
supports vital programs, preventive and systems building services
needed to promote optimal health--including the National Center for
Children's Vision and Eye Health.
advance and expand vision research opportunities
Prevent Blindness calls upon the Subcommittee to provide $730
million for the NEI to enable the agency to pursue its primary
``audacious goal'' of restoring vision by bolstering its efforts to
identify the underlying causes of eye disease and vision loss, improve
early detection and diagnosis of eye disease and vision loss, and
advance prevention and treatment efforts. Research is critical to
ensure that new treatments and interventions are developed to help
reduce and eliminate vision problems and potentially blinding eye
diseases facing consumers across the country. By providing additional
funding for the NEI at the NIH, essential efforts to identify the
underlying causes of eye disease and vision loss, improve early
detection and diagnosis of eye disease and vision loss, and advance
prevention, treatment efforts and health information dissemination will
be bolstered.
conclusion
On behalf of Prevent Blindness, our Board of Directors, and the
millions of people at risk for vision loss and eye disease, we thank
you for the opportunity to submit written testimony regarding fiscal
year 2015 funding for the CDC's vision and eye health efforts, the
MCHB's National Center for Children's Vision and Eye Health, and the
NEI. Please know that Prevent Blindness stands ready to work with the
Subcommittee and other Members of Congress to advance policies that
will prevent blindness and preserve sight. Please feel free to contact
us at any time; we are happy to be a resource to Subcommittee members
and your staff. We very much appreciate the Subcommittee's attention
to--and consideration of--our requests.
[This statement was submitted by Hugh Parry, President & CEO,
Prevent Blindness.]
______
Prepared Statement of the Prostatitis Foundation
Some young men have prostatitis before they even reach twenty years
of age, many older men have had symptoms for many years. You do not
hear about it as much as prostate cancer because men do not discuss
such issues with their friends, families and acquaintances. Many
couples assume there may be a stigma to having the annoying condition.
Even many urologists tell them there is no cure and they will just have
to live with it.
Prostatitis is a family affair as it presents itself as a disabling
pain accompanied by sexual dysfunction and infertility issues. It
usually causes a hesitant urination and an inability to empty the
bladder. Patients are sometimes unable to work and sometimes even
become suicidal.
Prostatitis is a huge financial drain as it tends to imitate
prostate cancer symptoms. The tests and procedures needed to rule out
prostate cancer are very expensive and often unnecessary but needed to
reassure the patient and his family. Prostatitis has been mentioned in
historical literature from previous times and generations ago.
The NIH has worked to find a cause and cure for (CP/CPPS) chronic
prostatitis/chronic pelvic pain syndrome for nearly twenty years. In
the latest research group called the MAPP Research Network they have
included other specialties than urologists to help find a clue to
prostatitis which affects 10 percent of men all over the world. It is
critical to fully fund those research efforts of the NIH and keep the
CDC involved.
[This statement was submitted by Mike Hennenfent, President,
Prostatitis Foundation.]
______
Prepared Statement of the Pulmonary Hypertension Association
Chairman Harkin and distinguished members of the Subcommittee,
thank you for your time and your consideration of the priorities of the
pulmonary hypertension community as you work to craft the fiscal year
2015 Labor, Health and Human Services Appropriations Bill.
about pulmonary hypertension
Pulmonary hypertension (PH) is a disabling and often fatal
condition simply described as high blood pressure in the lungs. It
affects people of all ages, races and ethnic backgrounds. Although
anyone can get PH, there are risk factors that make some people more
susceptible.
Treatment and prognosis vary depending on the type of PH. In one
type, pulmonary arterial hypertension (PAH), the arteries in the lungs
become too narrow to handle the amount of blood that must be pumped
through the lungs. This causes several things to happen: a backup of
blood in the veins returning blood to the heart; an increase in the
pressure that the right side of your heart has to pump against to push
blood through your lungs; and a strain on the right side of your heart
due to the increased work that it has to do. If this increased pressure
is not treated, the right side of your heart can become overworked,
become very weak and may possibly fail. Because the blood has
difficulty getting through the lungs to pick up oxygen, your blood
oxygen level may be lower than normal. This can put a strain not only
on your heart, but also decrease the amount of oxygen getting to your
brain.
There is currently no cure for PAH. Twelve treatment options are
available to help patients manage their disease and feel better day to
day but even with treatment, life expectancy with PAH is limited.
about the association
From simple beginnings--four women who met around a kitchen table
in Florida in 1990--the Pulmonary Hypertension Association has evolved
into a community of well over 10,000 pulmonary hypertension patients,
caregivers, family members and medical professionals.
As we have grown, we have stayed true to our roots and the vision
and ingenuity of our founders: We continue to work every day to end the
isolation that PH patients face, and find a cure for pulmonary
hypertension.
Research
PHA provides grants to promising researchers in the field of
pulmonary hypertension. The program fosters new leaders in the field by
supporting their interest in PH research and providing them with
opportunities to work with mentors and learn new skills. Researchers
supported by PHA are looking for new methods for early detection, new
treatments to prevent the onset of PH and ultimately a cure for this
terrible illness. To date, PHA has leveraged more than $13 million in
PH research funding through partnerships with the NIH and others.
Early Diagnosis Campaign
It takes too long for pulmonary hypertension to be diagnosed. The
median survival rate without treatment is approximately 2.8 years,
making the need to obtain a rapid and accurate diagnosis urgent.
Unfortunately, the median duration from symptom onset to a confirmed
diagnosis by right heart catheterization is 1.1 years. We are reaching
patients too late in the process. Almost three-fourths of patients have
advanced PH by the time they are diagnosed, leading more costly
treatments and poorer outcomes. For the most advanced cases of PH, a
lung or heart-lung transplant may be the only treatment option. The
goal of PHA's Early Diagnosis Campaign is to discover the disease
sooner in the early stages. This will allow the start of a treatment
regimen that can slow the progression of PH and secure a better life
for the patient.
Center Accreditation
The Pulmonary Hypertension Association's Scientific Leadership
Council, 28 global leaders in the field of pulmonary hypertension, have
spearheaded the PHA-Accredited PH Care Centers (PHCC) initiative. The
goal of this initiative is to establish a program for accreditation of
centers with special expertise in pulmonary hypertension (PH),
particularly pulmonary arterial hypertension (PAH), to raise the
overall quality of care and outcomes in patients with this life-
threatening disease.
one patient's story
In 2011, at the age of 29, GS12 Human Terrain Analyst Jessica
(Puglisi) Armstrong began experiencing shortness of breath and
dizziness. She was in Afghanistan at the time. Jessica was first
diagnosed with dehydration. Then, as is the case with many PH patients,
she was told she had asthma and was given an inhaler. Two months later,
she fainted for no apparent reason. An echocardiogram revealed blood
clots in her lungs and Jessica was medically evacuated to Germany and
then to the U.S. Six months after her fist symptoms, she was finally
given a complete work up and diagnosed with pulmonary hypertension.
Jessica, she had a unique form of PH due to blood clots that can be
mitigated with a pulmonary thromboendarterectomy (PTE)--a complex
surgery that involves opening the chest cavity and stopping circulation
for up to twenty minutes. She describes the surgery, which she
underwent at the University of California San Diego, as ``more painful
than I could ever imagine.'' She notes that UCSD's PTE program did not
begin until 1990 and even now, despite being recognized as the global
leaders on this procedure, has only completed about 3,000 surgeries.
The procedure that saved Jessica's was developed in her lifetime.
Jessica was terminated from Army employment and spent $60,000 out
of pocket on medical expenses which she has not been able to recoup.
She was forced to begin a civilian job just two weeks after her PTE in
order to retain health insurance. Despite this, Jessica is, in many
ways, one of the lucky ones. I am glad to report that she is now doing
well and serving an integral role at PHA as the coordinator of our
Early Diagnosis Campaign.
Over the past decade, treatment options, and the survival rate, for
pulmonary hypertension patients have improved significantly. However,
courageous patients of every age lose their battle with PH each day.
There is still a long way to go on the road to a cure and biomedical
research holds the promise of a better tomorrow.
sequestration
We have heard from the medical research community that
sequestration and deficit reduction activities have created serious
issues for Federal funding opportunities and the career development
pipeline. In order to ensure that the pulmonary hypertension research
portfolio can continue to grow, and, more importantly, to ensure that
our country is adequately preparing the next generation of young
investigators, we urge you to avert, mitigate, or otherwise eliminate
the specter of sequestration. The Association has anecdotal accounts of
the harms of sequestration and the Federated American Societies for
Experimental Biology has reported:
--In constant dollars (adjusted for inflation), the NIH budget in
fiscal year 2013 was $6 billion (22.4 percent) less than it was
in fiscal year 2003.
--The number of competing research project grants (RPGs) awarded by
NIH has also fallen sharply since fiscal year 2003. In fiscal
year 2013, NIH made 8,283 RPG awards, which is 2,110 (20.3
percent) fewer than in fiscal year 2003.
--Awards for R01-equivalent grants, the primary mechanism for
supporting investigator-initiated research, suffered even
greater losses. The number awarded fell by 2,528 (34 percent)
between fiscal year 2003 and fiscal year 2013.
The pay line for some NIH funding mechanisms has fallen from 18
percent to 10 percent while the average age for a researcher to receive
their first NIH-funded grant has climbed to 42. These are strong
disincentives to choosing a career as a medical researcher. Our
scaling-back is occurring at a time when many foreign countries are
investing heavily in their biotechnology sectors. China alone plans to
dedicate $300 million to medical research over the next 5 years; this
amount is double the current NIH budget over the same period of time.
Scientific breakthroughs will continue, but America may not benefit
from the return-on-investment of a robust biotechnology sector. For the
purposes of economic and national security, as well as public health,
the Association asks that you work with your colleagues to eliminate
sequestration and recommit to supporting this Nation's biomedical
research enterprise.
health resources and services administration
Due to the serious and life-threatening nature of PH, it is common
for patients to face drastic health interventions, including heart-lung
transplantation. Federal organ transplantation activities are
coordinated through HRSA. To ensure HRSA can expand its important
mission and continue to make improvements in donor lists and donor-
matching please provide HRSA with a meaningful funding increase in
fiscal year 2015.
centers for disease control and prevention
As a result of Federal investment in medical research, there are
now twelve FDA-approved treatments for PH. The effectiveness of these
therapies though is dependent on how early a patient can receive an
accurate diagnosis and begin treatment. Unfortunately, two-thirds of
patients are not diagnosed until PH has reached a late stage. In
addition to mitigating the impact of many treatments, late diagnosis
puts PH patients in a position to face interventions like heart-lung
transplantation and even death. CDC and NCCDPHP have the resources to
compliment PHA's own Sometimes its PH Early Diagnosis Campaign.
Improving public awareness and recognition of PH will not only save
lives, it can save the Federal healthcare system money. Please provide
CDC with meaningful funding increases so the agency can expand its
focus beyond winnable battles into increasingly important and cost-
effective areas.
national institutes of health
NIH hosts a sizable PH research portfolio. Further, NIH and PHA
have a strong track record of working together to advance our
scientific understanding of PH. The twelve FDA-approved treatments,
more than nearly every other rare disease, are evidence of the return-
on-investment from these activities. Please provide NIH with meaningful
increases to facilitate expansion of the PH research portfolio so we
can continue to improve diagnosis and treatment.
NCATS
The Office of Rare Diseases Research (ORDR), located within NCATS,
supports and coordinates rare disease research and provides information
on rare diseases to patients, their families, healthcare providers,
researchers and the public. In collaboration with other NIH institutes,
ORDR funds rare diseases research primarily through the Rare Diseases
Clinical Research Network (RDCRN), which supports clinical studies,
investigator training, pilot projects, and access to information on
rare diseases. The most recent funding opportunity announcement, which
was widely broadcast and open to all rare diseases, including PAH, was
issued in the fall of 2013 and awards are expected to be made in the
summer of 2014
NHLBI
The NHLBI-funded Centers for Advanced Diagnostics and Experimental
Therapeutics in Lung Diseases Stage II program, which will begin in
fiscal year 2014, will provide a mechanism to accelerate the
development of therapies for lung diseases, including pulmonary
fibrosis and pulmonary arterial hypertension.
additional activities
S. 1453
Senator Robert Casey (D-PA) has introduced the Pulmonary
Hypertension Research and Diagnosis Act (S.1453). This budget neutral
legislation has a bipartisan companion in the House due to its emphasis
on lowering healthcare costs by promoting efficiencies within the
Federal Government. S. 1453 seeks to establish an HHS-wide Committee
tasked with preparing a report on how to leverage limited resources to
improve early diagnosis of PH. Please consider cosponsoring S. 1453 and
working with your colleagues to advance this important legislation.
S. 2115
PHA has written to Senators Richard Durbin (D-IL) and Barbara
Mikulksi (D-MD) to thank them for their leadership on the American
Cures Act (S. 2115). We hope this legislation is an indication that
policymakers have committed themselves to supporting innovative
proposals to bolster and advance our Nation's biomedical research
enterprise.
______
Prepared Statement of Research!America
Research!America, the Nation's largest public education and
advocacy alliance committed to advancing medical research and
development, appreciates your stewardship over such a critical subset
of our Nation's discretionary funding priorities. As the subcommittee
begins the process of prioritizing fiscal year 2015 funding, we urge
you to consider the following thoughts on Federal agencies entrusted
with sustaining our Nation's sophisticated public health
infrastructure, partnering with the private sector to accelerate
medical progress, and optimizing healthcare outcomes.
The National Institutes of Health (NIH), the Centers for Disease
Control and Prevention (CDC), and the Agency for Healthcare Research
and Quality (AHRQ) play pivotal roles in combating disabling and deadly
health conditions. Moreover, the funding, or lack of it, allocated to
these agencies will bear on our Nation's ability to compete in key
export markets within the global economy, foster business development
that grows and maintains jobs across the country, meet our solemn
obligations to wounded warriors and support troops on the ground,
combat deadly medical errors, and protect our Nation against pandemics
and emerging health threats. The stakes truly are that high.
NIH as a driver of innovation
In fiscal year 2015, we urge you to provide at least $32 billion in
NIH funding to drive us beyond the stagnation that squanders
opportunities to advance science and strengthen our Nation. Research
funded by the NIH at universities, academic medical centers,
independent research institutions and small businesses across the
country lays the foundation for new product development by the private
sector. Since much of the research NIH supports is at the non-
commercial stages of the research pipeline, NIH funding does not
compete with, but rather sets the stage for, critical private sector
investment and development. These two complementary funding streams
lead to business development, job growth and beneficial medical
advances. Taxpayer-funded research through the NIH has helped our
Nation make remarkable progress against such insidious health threats
as childhood cancer, HIV-AIDS and heart disease.
The secrets of diabetes, Alzheimer's, Parkinson's, myriad cancers
and many other diseases can and will be unlocked by science. The
question is not if, but when . . . unless we dismiss the significance
of such progress and continue to allow research resources to stagnate.
And our Nation's best weapon against spiraling healthcare costs is
research. Ignoring growing healthcare costs is a ticket to disaster.
Alzheimer's disease alone is projected to cost the Federal Government
over $1 trillion during the next 20 years. Ultimately, we must prevent
and cure disease in order to tackle the costs associated with it.
CDC as a first responder
In fiscal year 2015, we urge you to provide a funding level that
continues the growth in CDC budget authority that was initiated in
fiscal year 2014. The CDC engages in research that stems deadly and
costly pandemics, bolsters our Nation's defenses against bioterrorism,
and helps prevent the onset of debilitating and expensive diseases. The
CDC is the Nation's first responder to lethal viruses and infections,
including life-threatening and costly drug-resistant infections that
pose a particular threat to children and young adults, as well as
investigating tragic phenomena like cancer clusters. Due to cuts in
recent years, the CDC is functioning with one hand tied behind its
back, even as health challenges like the obesity epidemic, autism
epidemic and infectious disease outbreaks capture headlines and ruin
lives. It is always more efficient and cost effective to be in front of
an outbreak or biological attack than to take reactionary measures.
AHRQ translates medical innovation into the right care at the right
time
In fiscal year 2015, we urge you to provide at least $375 million
in funding for AHRQ. Research supported by AHRQ identifies
inefficiencies in healthcare delivery that inflate the cost of public
and private insurance. AHRQ-supported research also combats medical
errors and improves the quality of care to help reduce the length and
intensity of disability and disease. It helps patients and physicians
make informed treatment decisions that improve outcomes and reduce
costly ``false starts'' in the provision of healthcare services.
Just one of many success stories is AHRQ's issuance of new
standards of care and practices related to central line-associated
bloodstream infections. The implementation of the guidelines resulted
in a reduction of up to two-thirds of cases during early rollout
studies. With an annual estimated 80,000 cases, up to 28,000 deaths and
an average cost per patient of $45,000, this has the potential to save
$2.3 billion annually in healthcare costs. Given the enormity of the
challenge of inefficiency in healthcare delivery, AHRQ is severely
underpowered.
The threat of sequestration's return
The Ryan-Murray Bipartisan Budget Act provided America with 2 years
of partial relief from sequestration after across the board budget cuts
dramatically impacted medical research in March 2013. Unfortunately,
sequestration will go back into full effect in 2016 unless Congress
takes action, and it will be in effect for 2 years longer than
originally established under the 2011 Budget Control Act. The return of
sequestration's budget cuts to discretionary spending, including that
for NIH, CDC and AHRQ, poses potentially devastating setbacks to
medical research. Short-changing medical research is not a solution to
the Federal deficit or debt. On the contrary, neglecting medical
research undercuts strategies to fight chronic disease and the
multipronged Federal costs that arise from it, while squandering
opportunities to increase private sector and Federal revenues through
new medical innovations.
Research!America appreciates the difficult task facing the
subcommittee as it seeks to simultaneously confront the budget deficit,
strengthen the U.S. and promote the well-being of Americans. There are
few Federal investments that confer as many benefits as medical
research--new cures, new businesses, new jobs, new solutions to
healthcare cost inflation, and new fuel to drive U.S. leadership in a
global economy shaped by the ability of countries to continuously
innovate. We firmly believe that investing in NIH, CDC and AHRQ is a
means of advancing all three of these fundamental goals. Thank you for
your leadership and consideration; we know that your task is
extraordinarily difficult, and that our Nation is fortunate to have
such pragmatic, committed and gifted leaders at the helm.
______
Prepared Statement of the Research Working Group
Chairman Harkin, Ranking Member Moran, and members of the
Committee, thank you for the opportunity to provide testimony on the
National Institutes of Health (NIH) budget overall and for AIDS
research in fiscal year 2015. Tomorrow's scientific and medical
breakthroughs depend on your vision, leadership, and commitment to
robust NIH funding this year. To this end, the Research Working Group
(RWG) urges this Committee to support a funding target of $36 billion
in fiscal year 2015 to maintain the United States' position as the
world leader in medical research and innovation.
Investments in health research via the NIH have paid enormous
dividends in the health and wellbeing of people in the U.S. and around
the world. NIH-funded HIV and AIDS research has supported innovative
basic science for better drug therapies, evidence-based behavioral and
biomedical prevention interventions, and vaccines that have saved and
improved the lives of millions, and holds great promise for
significantly reducing HIV infection rates and providing more effective
treatments for those living with HIV/AIDS in the coming decade.
Despite these advances, the number of new HIV/AIDS cases continues
to rise in the U.S. and around the world. There are 1.1 million HIV-
infected people in the U.S., the highest number in the epidemic's more
than 30 year history; additionally over 50,000 Americans become newly
infected every year. In 2012, 35.3 million were infected with HIV/AIDS
worldwide, 1.6 million died from the disease and 2.3 million people
were newly infected. With proper funding, we can capitalize on the
ongoing scientific progress in therapeutics and prevention science,
vaccines, and finding a cure for HIV, as well as addressing the
comorbidity such as viral hepatitis and tuberculosis that affect
patients living with HIV.
Major advances over the last few years in HIV prevention
technologies--with HIV vaccines, medical male circumcision,
antiretroviral treatment as prevention, and pre-exposure prophylaxis
using antiretrovirals (PrEP) --demonstrate that adequately resourced
NIH programs can transform our lives. Because HIV disease entails many
common co-morbidities, HIV research funding is spread across the
Institutes and Centers--and HIV research discoveries have had broad
benefits for many other conditions including: aging, cancer,
immunosuppression and auto-immune disorders, heart disease, stroke,
Alzheimer's disease, osteoporosis, viral hepatitis, and influenza,
among others. Federal support for AIDS research has led to new
treatments for other diseases, including cancer, heart disease,
Alzheimer's, hepatitis, osteoporosis, and a wide range of autoimmune
disorders.
Over the years, the NIH has sponsored the evaluation of a host of
vaccine candidates, some of which are advancing to efficacy trials. The
successful iPrEx and HPTN 052 trials have shown the potential of
antiretroviral drugs to prevent HIV infection. Moreover, increased
funding will support the future testing of new vaccines, microbicides
and therapeutics in the pipeline via the newly restructured, cross-
cutting NIAID clinical trials network that translates NIH-funded
scientific innovation into critical quality-of-life gains.
It is also essential to note that NIH-funded HIV pathogenesis and
clinical research has contributed substantially to our understanding of
potential curative approaches. The NIAID clinical trial networks
comprise one of the largest groups of clinical research sites in the
world and have been instrumental to the progress made in response to
the HIV epidemic domestically and globally. These networks are now
taking on the challenges of tuberculosis and hepatitis C and have
dramatically expanded the opportunities to test new drugs and other
critically needed interventions to advance knowledge in these leading
infectious disease killers.
Increased funding for the NIH in fiscal year 2015 makes good
bipartisan economic sense, especially in shaky fiscal times. Robust
funding for the NIH overall will enable research universities to pursue
scientific opportunity, advance public health, and create jobs and
economic growth. In every State across the country, the NIH supports
research at hospitals, universities, private enterprises, and medical
schools. This includes the creation of jobs that will be essential to
future discovery. Sustained investment is also essential to train the
next generation of scientists and prepare them to make tomorrow's HIV
discoveries. NIH funding puts 350,000 scientists to work at research
institutions across the country. According to the NIH, each of its
research grants creates or sustains six to eight jobs, and NIH-
supported research grants and technology transfers have resulted in the
creation of thousands of new, independent private-sector companies.
Strong, sustained NIH funding is a critical national priority that will
foster better health and economic revitalization.
Since 2003, funding for the NIH has failed to keep up with our
existing research needs--damaging the success rate of approved grants
and leaving very little money to fund promising new research. The real
value of the increases prior to 2003 has precipitously declined because
of the relatively higher inflation rate for the cost of research and
development activities undertaken by the NIH. According to the
Biomedical Research and Development Price Index, which calculates how
much the NIH budget must change each year to maintain purchasing power,
between fiscal year 2003 and fiscal year 2014, the cost of NIH
activities increased by 38.1 percent. By comparison, the overall NIH
budget increased by 10.8 percent, over fiscal year 2003. So in real
terms, the NIH has already sustained budget decreases of close to 30
percent over the past decade due to inflation alone! As such, flat
funding or cuts to the NIH will have the clear and devastating effects
of undermining our Nation's leadership in health research and our
scientists' ability to take advantage of the expanding opportunities to
advance healthcare. The race to find better treatments and a cure for
cancer, heart disease, AIDS, and other diseases, and for controlling
global epidemics like AIDS, tuberculosis, and malaria, all depend on a
robust long-term investment strategy for health research at NIH.
In conclusion, the RWG calls on Congress to continue the bipartisan
Federal commitment towards combating HIV as well as other chronic and
life-threatening illnesses by increasing funding for the NIH to $36
billion in fiscal year 2015. A meaningful commitment to stemming the
epidemic and securing the well being of people with HIV cannot be met
without prioritizing the research investment at the NIH that will lead
to tomorrow's lifesaving vaccines, treatments, and cures. Thank you for
the opportunity to provide these written comments.
______
Prepared Statement of the Rotary International
Chairman Harkin, members of the Subcommittee, Rotary International
appreciates this opportunity to submit testimony in support of the
polio eradication activities of the U. S. Centers for Disease Control
and Prevention (CDC). The Global Polio Eradication Initiative (GPEI) is
an unprecedented model of cooperation among national governments, civil
society and UN agencies working together to reach the most vulnerable
children through the safe, cost-effective public health intervention of
polio immunization. We appeal to this Subcommittee for continued
leadership to ensure we seize the opportunity to conquer polio once and
for all. Rotary International strongly supports the President's 2015
request of $161 million for the polio eradication activities of the CDC
to enable full implementation of the polio eradication strategies and
innovations outlined in the Polio Eradication and Endgame Strategic
Plan (2013-2018).
progress in the global program to eradicate polio
Significant strides were made in 2013 toward stopping transmission
of polio. Thanks to this committee's leadership in appropriating funds
for the polio eradication activities of the CDC:
--India was certified polio free in February 2014, following 3 years
with no cases of polio. The entire Southeast Asia region was
certified polio free on 27 March 2014.
--Eradication efforts have led to more than a 99 percent decrease in
cases since the launch of the GPEI in 1988.
--The number of polio cases in the endemic countries was 40 percent
lower in 2013 than in 2012 (160 vs. 217). Afghanistan and
Nigeria each had less than half the number of cases in 2013
that they had in 2012.
--Pakistan is now considered to be the only country in the world with
uncontrolled transmission of wild polio and as of 20 March,
accounts for more than 75 percent of polio cases in 2014.
--Outbreaks in the Horn of Africa and Syria accounted for roughly 60
percent of all cases in 2013. These outbreaks underscore the
risk to polio-free countries until the wild poliovirus has been
eradicated in the remaining places where it persists.
--Incidence of type 3 polio is at historically low levels. There have
been no cases of type 3 polio since November 2012.
--Lack of access to children in insecure areas continues to hamper
progress. In Pakistan alone, more than 50 health workers and
security personnel assigned to protect them have been killed in
targeted attacks since November of 2012. Insecurity/inability
to access large populations is now a key factor in all endemic
transmission zones and is also a factor in outbreak areas
(Syria, Horn of Africa).
The Polio Eradication and Endgame Strategic Plan (2013-2018)
launched in 2013 lays out the strategies for the certification of the
eradication of wild poliovirus by 2018 at a total global cost of US$5.5
billion. This new plans builds on the lessons learned from the
successful eradication of polio to date and the substantial advances in
technology in 2012. The timely availability of funds remains essential
to the achievement of a polio free world. The United States has been
the leading public sector donor to the Global Polio Eradication
Initiative. Members of U.S. Rotary clubs appreciate the United States'
generous support and recognize increased funding provided by Congress
in fiscal year 2014 to ensure the GPEI can fully implement the plan.
Rotarians are committed to continuing their own fundraising for the
program until the world is certified polio free. Rotarians will also
continue to advocate support from the public and other governments,
both polio free and polio affected, to support the successful execution
of the Strategic Plan. The ongoing support of donor countries, like the
United States, is essential to assure the necessary human and financial
resources are made available to polio-endemic and at risk countries to
certify the world polio free by the end of 2018.
the role of rotary international
Rotary International, a global association of more than 34,000
Rotary clubs in more than 170 countries with a membership of over 1.2
million business and professional leaders (more than 345,000 of which
are in the U.S.), has been committed to battling polio since 1985.
Rotary International has contributed more than US$1.2 billion toward a
polio free world--representing the largest contribution by an
international service organization to a public health initiative ever.
Rotary also leads the United States Coalition for the Eradication of
Polio, a group of committed child health advocates that includes the
March of Dimes Foundation, the American Academy of Pediatrics, the Task
Force for Global Health, the United Nations Foundation, and the U.S.
Fund for UNICEF. These organizations join us in thanking you for your
support of the GPEI.
the role of the u.s. centers for disease control and prevention
Rotary commends CDC for its leadership in the global polio
eradication effort, and greatly appreciates the Subcommittee's
increased support of CDC's polio eradication activities to support full
implementation of the Strategic Plan. The United States is the leader
among donor nations in the drive to eradicate this crippling disease.
CDC is using the increased Congressional support provided in fiscal
year 2014 to:
--Build capacity in Nigeria. Increased investment in Nigeria will
serve to establish and broaden environmental surveillance;
strengthen traditional AFP surveillance, scale up the National
Stop Transmission of Polio Program (N-STOP) in Kano and other
high risk polio States to ensure broad coverage at the Local
Government Authority Level, trapping poliovirus in its
remaining reservoirs in Northern Nigeria.
--Build capacity in Pakistan. Increased investment in Pakistan will
focus on training and placing local personnel to strengthen the
program in areas where access is possible.
--Provide essential technical assistance in Afghanistan. The
investment in Afghanistan will support two staff members in
country.
--Laboratory Surveillance: Investment with CDC's Polio Global
Reference Lab will allow the recruitment of additional staff,
training for country and regional labs, essential IPV research,
and expansion of environmental surveillance capabilities in the
field. CDC provides technical and programmatic assistance to
the global polio laboratory network through the Polio
Laboratory in CDC's Division of Viral Diseases. CDC's labs
provide critical diagnostic services and genomic sequencing of
polioviruses to help guide disease control efforts. CDC will
continue to serve as the global reference laboratory, while
expanding environmental surveillance in countries to serve as a
``safety measure'' to detect any polioviruses circulating in
areas without cases.
--Vaccine Purchase: CDC funds are being used to purchase oral polio
vaccine to immunize children against polio.
--Vaccine Operations & Social Mobilization. CDC, through its
cooperative agreement with WHO, provides funding for
immunization activities in high risk and polio infected
countries. CDC funding is essential to supporting the
supplemental immunization activities that both stop existing
outbreaks and prevent new outbreaks. CDC collaborates closely
with UNICEF and provides critical support on analysis and use
of campaign results to identify and address reasons why
children are missed and address vaccine hesitancy concerns.
--Immunization Systems Strengthening. Investment in this area will
allow CDC to provide scientific assistance across a range of
topics related to the introduction of IPV to focus countries,
other GAVI-eligible countries, and to non-eligible countries.
Continued funding will allow CDC to fully capitalize on the
resources of the Emergency Operation Center to provide direct support
and build capacity to continue intense supplementary immunization
activities in the remaining polio-affected countries, continue
leadership on data management to drive evidence-based decisionmaking,
and continue to implement strategies to increase effective management
and accountability. These funds will also help maintain essential
certification standard surveillance.
benefits of polio eradication
Since 1988, over 10 million people who would otherwise have been
paralyzed are walking because they have been immunized against polio.
Tens of thousands of public health workers have been trained to manage
massive immunization programs and investigate cases of acute flaccid
paralysis. Cold chain, transport and communications systems for
immunization have been strengthened. The global network of 145
laboratories and trained personnel established by the GPEI also tracks
measles, rubella, yellow fever, meningitis, and other deadly infectious
diseases and will do so long after polio is eradicated.
A study published in the November 2010 issue of the journal Vaccine
estimates that the GPEI could provide net benefits of at least $40-50
billion. Polio eradication is a cost-effective public health investment
with permanent benefits. On the other hand, as many as 200,000 children
could be paralyzed annually in the next 10 years if the world fails to
capitalize on the more than $10 billion already invested in
eradication. Success will ensure that the significant investment made
by the U.S., Rotary International, and many other countries and
entities, is protected in perpetuity.
______
Prepared Statement of the Ryan White Medical Providers Coalition
My name is Dr. James Raper, and I serve as the Director of the 1917
HIV/AIDS Outpatient Clinic at the University of Alabama at Birmingham.
I am writing to submit testimony on behalf of the Ryan White Medical
Providers Coalition (RWMPC), which I co-chaired from 2010-2013. I
remain a member of the RWMPC Steering Committee. Thank you for the
opportunity to describe the lifesaving HIV/AIDS care and treatment
provided by Ryan White Part C funded programs, including those provided
at my own clinic.
RWMPC is a national coalition of medical providers and
administrators who work in clinics supported by the Ryan White HIV/AIDS
Program funded by the HIV/AIDS Bureau (HAB) at the Health Services and
Resources Administration (HRSA). I thank the Subcommittee for its
support of Ryan White Part C Programs in fiscal year 2014. And while I
am grateful for this support, and understand that times are tough, I
request $225.1 million, or a $24 million increase for Ryan White Part C
programs in fiscal year 2015. While I know that this is a lot of
funding, it is in fact well below the estimated need, and Ryan White
providers would spend those dollars identifying, engaging and treating
persons living with HIV/AIDS--an infectious disease that can be
effectively prevented and treated in a way that saves both lives and
money.
The 1917 Clinic is a dedicated, not-for profit outpatient HIV/AIDS
medical and dental clinic established in 1988 at the University of
Alabama at Birmingham. Ryan White Part C funding provides critical
assistance in helping the clinic meet the needs of our patients. Today,
35 percent of the 1917 Clinic's patients are uninsured and would be at
risk for losing access to lifesaving services without Ryan White
Program funding.
The 1917 Clinic provides comprehensive outpatient HIV primary care
services to residents of Jefferson, Walker, Winston, Cullman, Blount,
St. Clair, and Shelby counties. Although our service area technically
includes only these seven counties, we serve people with HIV/AIDS
throughout Alabama and its neighboring States. In February 2013, the
1917 Clinic absorbed 800+ new patients from the previously Ryan White
Part C funded Cooper Green Hospital's St. Georges' Clinic, which closed
on January 31, 2013. The 1917 Clinic is now providing care to 2,950
adult patients--this represents approximately 24 percent of the 12,404
known adults living with HIV/AIDS in Alabama.
The clinic offers a range of primary care and social services
critical to successful HIV treatment, including primary medical and
oral healthcare; on-site case management; mental health and substance
abuse treatment services; onsite access to clinical trials; medication
adherence; spiritual, risk reduction, and nutrition counseling;
infusion therapy; coordination of hospital discharge planning; and home
healthcare/hospice referral. To avoid emergency room visits, the 1917
Clinic provides `sick call' services five days a week. Subspecialty
care is available at the University's Kirklin Clinic--which is located
just two blocks from the 1917 Clinic.
In addition to critical funding that Ryan White Part C provides
through direct Federal grants for comprehensive medical care clinics
like the 1917 Clinic, most Part C clinics, including the 1917 Clinic,
also receive support from other Parts of the Ryan White Program that
help support access to medication; additional medical care, such as
dental services; and key support services, such as case management and
transportation, which are essential components of the highly effective
Ryan White HIV care model that result in excellent outcomes for our
patients.
Ryan White Part C Programs Support Comprehensive, Expert and Effective
HIV Care
Part C of the Ryan White Program funds comprehensive, expert and
effective HIV care and treatment--services that are directly
responsible for the dramatic decrease in AIDS-related mortality and
morbidity over the last decade. The Ryan White Program has supported
the development of expert HIV care and treatment programs that have
become patient-centered medical homes for individuals living with this
serious, chronic condition. In 2011, a ground-breaking clinical trial--
named the scientific breakthrough of the year by Science magazine--
found that HIV treatment not only saves the lives of people with HIV,
but also reduces HIV transmission by more than 96 percent--proving that
HIV treatment is also HIV prevention.
The comprehensive, expert HIV care model that is supported by the
Ryan White Program has been highly successful at achieving positive
clinical outcomes with a complex patient population.\1\ In a
convenience sample of eight Ryan White-funded Part C programs ranging
from the rural South to the Bronx, retention in care rates ranged from
87 to 97 percent. In estimates from the Centers for Disease Control and
Prevention (CDC), only 37 percent of all people with HIV are in regular
care nationally.\2\ Once in care, patients served at Ryan White-funded
clinics do well-- with 75 to 90 percent having undetectable levels of
the virus in their blood. This is much higher than the estimate from
the CDC that just 25 percent of all people living with HIV in the U.S.
are virally suppressed.
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\1\ 1 See Improvement in the Health of HIV-Infected Persons in
Care: Reducing Disparities at http://cid.oxfordjournals.org/content/
early/2012/08/24/cid.cis654.full.pdf+html.
\2\ See CDC's HIV in the United States: The Stages of Care http://
www.cdc.gov/nchhstp/newsroom/docs/2012/Stages-of-CareFactSheet-508.pdf.
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Investing in Ryan White Part C Programs Saves Both Lives and Money
Early and reliable access to HIV care and treatment both helps
patients with HIV live relatively healthy and productive lives and is
more cost effective. One study from the 1917 Clinic at the University
of Alabama at Birmingham found that patients treated at the later
stages of HIV disease required 2.6 times more healthcare dollars than
those receiving earlier treatment meeting Federal HIV treatment
guidelines. On average it costs $3,501 per person per year to provide
the comprehensive outpatient care and treatment available at Part C
funded programs. The comprehensive services provided often include lab
work, STD/TB/Hepatitis screening, ob/gyn care, dental care, mental
health and substance abuse treatment, and case management.
Current Challenges--Future Promise
However, this effective and comprehensive HIV care model is not
completely supported by Medicaid or most private insurance. While many
Ryan White Program clients have some form of insurance coverage,
without the Ryan White Program, they would risk falling out of care.
Barriers include poor reimbursement rates; benefits designed for
healthier populations that fail to cover critical services, such as
care coordination; and inadequate coverage for other important
services, such as extended medical visits, mental health and substance
use treatment. Full implementation of the Affordable Care Act plus
continuation of the Ryan White Program will dramatically improve health
access and outcomes for many more people living with HIV disease.
Fully Funding and Maintaining Ryan White Part C Programs Is Essential
Because of both the inadequacy of insurance coverage for people
with complex conditions like HIV and the fact that some individuals
will remain uncovered, even with Affordable Care Act implementation
(particularly in the non-Medicaid expansion States), fully funding and
maintaining the Ryan White Program is essential to providing
comprehensive, expert and effective HIV care nationwide.
And while RMWPC is concerned about the proposal to consolidate Ryan
White Part D funding into Part C, it welcomes the $4 million increase
for Part C programs proposed in the President's fiscal year 2015
budget. RWMPC's specific concerns include:
--Part D funding supports effective HIV care and treatment services
for vulnerable populations, including women and adolescents.
With adolescents accounting for 39 percent of new HIV
infections in the U.S., it is critical to target resources to
support comprehensive services that effectively engage and
retain young people in HIV care and treatment.
--In some communities, Part D-funded programs are the main providers
of HIV care and treatment. It is critical to ensure that
implementation of any budget proposal does not leave any
community without adequate access to effective and
comprehensive HIV care and treatment. Also, for Ryan White
medical clinics that currently receive only Part D funding, it
could prove difficult to successfully compete for Part C
funding if there currently exists a Part C program serving that
community. Loss of the aforementioned Part D program would
reduce the community's access to HIV care and treatment.
--It is unclear how the proposed consolidation would be implemented.
At this time it is unclear what the consolidation process would
entail and how it would practically impact grantees and access
to HIV care and treatment in communities. Since most Ryan White
medical clinics receive funding from multiple parts of the Ryan
White Program, reduction of funding to one part can have
damaging and unintended consequences to the overall services
provided by Ryan White medical clinics, especially now, at a
time when providers are working to expand access to HIV care
and treatment.
At this critical time in the HIV/AIDS epidemic, when research has
confirmed that early access to HIV care and treatment not only saves
lives but prevents new infections by reducing the risk of transmission
to near zero for patients who are virally suppressed, it is essential
to maintain overall funding levels for the Ryan White Program. While
the ACA provides important new healthcare coverage options for many
patients, most health insurers fail to support the comprehensive care
and treatment necessary for many patients to manage HIV infection.
Exorbitant cost sharing, benefit gaps and limited State uptake of the
Medicaid expansion necessitate a vital and ongoing role for the Ryan
White Program. Increasing access to and successful engagement in
effective, comprehensive HIV care and treatment is the only way to lead
the Nation to an AIDS-free generation and reduce the devastating costs
of--including lives lost to--HIV infection.
Conclusion
Thank you very much for your consideration of RWMPC's fiscal year
2015 request of $225.1 million for Ryan White Part C programs, a $24
million increase over fiscal year 2014.
[This statement was submitted by James L. Raper, PhD, CRNP, JD,
FAANP, FAAN; Director, 1917 HIV/AIDS Outpatient Clinic; Professor of
Medicine & Nursing.]
______
Prepared Statement of the Safe States Alliance
Safe States Alliance, the national membership association dedicated
to strengthening the practice of injury and violence prevention,
appreciates the opportunity to provide testimony in support of the
Centers for Disease Control and Prevention (CDC). Safe States Alliance
requests that the CDC's National Center for Injury Prevention and
Control (Injury Center) receive $205.5M in fiscal year 15--an
additional $29.7M for the Core Violence and Injury Prevention Program
(VIPP), including resources to meaningfully address the epidemic of
prescription drug misuse, abuse and overdose; and an additional $13.7M
for the National Violent Death Reporting System (NVDRS). Safe States
Alliances also supports continued funding of the CDC's Preventive
Health and Health Services (PHHS) Block Grant at $180 million.
background
In 1985, the Institute of Medicine (IOM) first called attention to
the lack of recognition and funding for injury and violence prevention
(IVP) as a public health issue in the United States.\1\ Although some
progress has been made in subsequent years, injuries and violence
continue to have a significant impact on the health of Americans and
the healthcare system, as more people ages 1-44 die from injuries than
from any other cause, including cancer, HIV, or the flu.\2\
---------------------------------------------------------------------------
\1\ National Research Council. Injury in America: A Continuing
Public Health Problem. Washington, DC: The National Academies Press,
1985.
\2\ Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control. Web-based Injury Statistics Query and
Reporting System (WISQARS) [online] (2007) [accessed 2013 Feb 15].
Available from URL: http://www.cdc.gov/injury/wisqars.
---------------------------------------------------------------------------
Injuries and violence are serious public health problems. Areas
include:
Assault & Homicide
Bullying
Child Maltreatment
Child Passenger Safety
Disaster Response
Domestic & Intimate Partner Violence
Drowning
Elder Abuse
Falls
Fire & Burns
Motor Vehicle Safety
Pedestrian & Bicycle Safety
Poisoning & Prescription Drug Overdose
Sexual Assault & Rape
Suicide
Traumatic Brain Injury
Youth Violence
In fact, more than 29 million people are treated in emergency
departments each year, two million are hospitalized, and approximately
180,000 people die--one person every three minutes. Every 45 minutes,
one of those preventable deaths is a child.\2\ In a single year,
injuries and violence will ultimately cost $406 billion in medical
costs and lost productivity.\3\ Yet to date, there is no national
program to support State public health IVP programs.
---------------------------------------------------------------------------
\3\ Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control. Web-based Injury Statistics Query and
Reporting System (WISQARS) [online] (2007) [accessed 2013 Feb 15].
Available from URL: http://www.cdc.gov/injury/wisqars
---------------------------------------------------------------------------
At the Federal level, the CDC Injury Center serves as the focal
point for the public health approach to IVP. The CDC Injury Center only
receives approximately 2 percent of the CDC/Agency for Toxic Substances
and Disease Registry budget to address the significant burden of
injuries and violence nationwide. In fiscal year 2013, the total Injury
Center budget was only $138.9 million.
core violence and injury prevention program (vipp) and new prescription
drug overdose prevention expanded component
Given its limited budget, the CDC Injury Center currently provides
small capacity building grants of approximately $250,000 to only 20
State health departments (SHDs) through the Core Violence and Injury
Prevention Program (VIPP). The Core VIPP is comprised of multiple
components including: Basic Prevention (20 States); Regional Network
Leaders (5 States); Surveillance Quality Improvement (4 States); Older
Adult Falls Prevention (3 States); and Motor Vehicle/Child Injury
Prevention (4 States). The President's 2015 Budget Request includes an
increase of approximately $15.6M to expand the number of funded Core
VIPP programs ($5.6M) and to allow for the development of a new
expanded component for States to address the epidemic of prescription
drug misuse, abuse and overdose ($10 million).
Opioid pain relievers are now involved in more overdose deaths than
cocaine and heroin combined. The abuse of prescription opioid pain
relievers costs up to $72 billion annually. The CDC Injury Center
provides leadership in enhancing drug overdose surveillance,
identifying and evaluating effective program and policy interventions
for preventing overdoses, improving clinical practice to reduce
prescription drug diversion and abuse, and equipping and empowering
States with the information and resources they need to reverse the
epidemic. Core VIPP States would be funded to advance promising
surveillance and prevention strategies and would complement other
Federal agencies, such as SAMHSA's work on screening, treatment and
community prevention activities. State health departments are well
positioned to coordinate the necessary multi-sector responses to
reverse the epidemic through the regulation of healthcare
professionals, prescription drug monitoring programs, and other major
levers for preventing prescription drug abuse.
Ohio's Core Violence and Injury Prevention Program (VIPP) provides
statewide leadership and funding for community-based efforts to address
prescription drug abuse and overdose through the PHHS Block Grant from
CDC. The OH VIPP coordinates the development and implementation of
statewide prevention strategies, conducts surveillance, supports the
Governor's Cabinet Opiate Action Team Prescriber Education Work Group
including the development of opioid prescribing guidelines, and
provides support and technical assistance to expand naloxone
distribution programs. Examples of locally PHHS Block Grant funded
strategies include: expanding access to naloxone distribution programs;
facilitating healthcare system changes such as implementation of opioid
prescribing guidelines and other pain management strategies; obtaining
commitment of prescribers to use the Ohio prescription drug monitoring
program; and expanding access to sustainable drug disposal options.
With overall program funding of $29.7M, the CDC Injury Center could
support injury and violence prevention programs in ALL States and
territories, much as it does for other key public health issues
including chronic and infectious diseases, as well as make significant
strides in reversing the prescription drug overdose epidemic.
national violent death reporting system (nvdrs)
NVDRS is a state-based surveillance system that uses information
from a variety of States and local agencies and sources--medical
examiners, coroners, police, crime labs and death certificates--to form
a more complete picture of the circumstances that surround violent
deaths. State and local violence prevention practitioners use these
data to guide their prevention programs, policies and practices
including: identifying common circumstances associated with violent
deaths of a specific type (e.g. gang violence) or a specific area (e.g.
a cluster of suicides); assisting groups in selecting and targeting
violence prevention efforts; supporting evaluations of violence
prevention activities; and improving the public's access to in-depth
information on violent deaths. CDC Injury Center currently funds 18
States to implement NVDRS and received an approximately $7.9M increase
in fiscal year 2014 to expand number of participating States up to 30-
35 States.
The Oregon Older Adult Suicide Prevention Advisory Work Group and
the Oregon Department of Human Services used NVDRS data to inform
efforts to develop and focus suicide prevention programs for older
adults. Almost 50 percent of men ages 65 and older who died by suicide
were reported to have a depressed mood before death, but only a small
proportion were receiving treatment, suggesting screening and treatment
for depression might have saved lives. As a result, Oregon developed
primary care recommendations in 2006 to better integrate with mental
health services so that suicidal behavior and ideation are diagnosed
and older adults received appropriate treatment. These recommendations
were implemented as part of Oregon's ``Healthy Aging'' efforts. The
recommendations include the objectives of increasing the confidence and
competence of primary care providers and other clinicians to identify,
assess and treat older adult suicide behavior and depression. The
suicide rates among males ages 65 and older in Oregon decreased
approximately 8 percent from 2007 to 2010.
Safe States Alliance supports the investment of an additional $13.7
million to expand NVDRS to all States and territories.
preventive health and health services (phhs) block grant
For more than 30 years, the PHHS Block Grant has remained an
essential source of Federal agencies to support State solutions to
State health problems. The PHHS Block Grant allows each State to
respond to its own distinct health priorities and need. In fiscal year
2011, more than 20 percent of the Prevent Block Grant was used by
States to support IVP and emergency medical services. According to a
2011 survey conducted by Safe States Alliance, 29 States reported
receiving an average of $329,000 from the Prevent Block Grant for IVP
efforts.\4\ The Prevent Block Grant is a critical source of funding for
SHD IVP programs representing 9.4 percent of total State funding in
2011. Safe States Alliance supports continued funding of the PHHS Block
Grant at the $180 million level.
---------------------------------------------------------------------------
\4\ State of the States: 2011 Report. Atlanta, GA: Safe States
Alliance; 2013.
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Preventable injuries exact a heavy burden on Americans through
premature deaths and disabilities, pain and suffering, medical and
rehabilitation costs, disruption of quality of life for families, and
disruption of productivity for employers. Strengthening investments in
public health IVP programs is a critical step to keep Americans safe
and productive for the 21st century. Safe States Alliance would like to
thank the Committee for consideration of this testimony.
[This statement was submitted by Amber Williams, Executive
Director, Safe States Alliance.]
______
Prepared Statement of the Scleroderma Foundation
Chairman Harkin and distinguished members of the Subcommittee,
thank you for your time and your consideration of the scleroderma
community's priorities while working to craft the fiscal year 2015
Labor, Health and Human Services Appropriations Bill.
about scleroderma
Scleroderma, or systemic sclerosis, is a chronic connective tissue
disease generally classified as one of the autoimmune rheumatic
diseases.
The word ``scleroderma'' comes from two Greek words: ``sclero''
meaning hard, and ``derma'' meaning skin. Hardening of the skin is one
of the most visible manifestations of the disease. The disease has been
called ``progressive systemic sclerosis,'' but the use of that term has
been discouraged since it has been found that scleroderma is not
necessarily progressive. The disease varies from patient-to-patient.
It is estimated that about 300,000 Americans have scleroderma.
About one third of those people have the systemic form of scleroderma.
Since scleroderma presents with symptoms similar to other autoimmune
diseases, diagnosis is difficult. There may be many misdiagnosed or
undiagnosed cases.
Localized scleroderma is more common in children, whereas systemic
scleroderma is more common in adults. Overall, female patients
outnumber male patients at a ratio of 4-to-1. Factors other than
gender, such as race and ethnic background, may influence the risk of
getting scleroderma, the age of onset, and the pattern or severity of
internal organ involvement. The reasons for this are still unknown.
Although scleroderma is not directly inherited, some scientists feel
there is a slight predisposition to it in families with a history of
rheumatic or autoimmune diseases. While, scleroderma can develop in
every age group from infants to the elderly, its onset is most frequent
between the ages of 25 to 55.
Currently, there is no cure for scleroderma. Treatments are based
on a patient's particular symptoms. For instance, heartburn can be
controlled by medications called proton pump inhibitors or medicine to
improve the motion of the bowel. Some treatments are directed at
decreasing the activity of the immune system. Due to the fact that
there is so much variation from one person to another, there is great
variation in the treatments prescribed.
Any chronic disease can be serious. The symptoms of scleroderma
vary greatly for each person, and the effects of scleroderma can range
from mild to life threatening. The seriousness will depend on which
organ systems of the body are affected, and the extent to which they
are affected. A mild case can become more serious if not properly
treated. Prompt and proper diagnosis and treatment by qualified
physicians may minimize the symptoms of scleroderma and lessen the
chance for irreversible damage.
about the foundation
The non-profit Scleroderma Foundation is the national organization
for people with scleroderma and their families and friends. It was
formed January 1, 1998, by a merger between the West Coast-based United
Scleroderma Foundation and the East Coast-based Scleroderma Federation.
The national office is headquartered in Danvers, Massachusetts. The
Foundation has a three-fold mission of support, education, and
research.
Support
The Scleroderma Foundation offers the following tools and resources
in support of people living with scleroderma and their families:
--A nationwide network of 24 chapters and more than 150 support
groups
--A toll-free helpline providing information and referrals to callers
--Educational materials, including a quarterly magazine called
``Scleroderma Voice"
--Offer a variety of brochures, booklets and newsletters, along with
our informative website
Additionally, the Foundation hosts an annual National Patient
Education Conference. The conference offers various educational and
networking opportunities for people living with scleroderma, their
caregivers, family members and friends. Workshops, panel discussions
and other educational sessions are led by the leading scleroderma
researchers and healthcare professionals.
Education
As part of our education mission, we not only perform all the
functions mentioned above, we also work with our Medical Advisory Board
of internationally known scleroderma experts to provide patient
education programs as well as education for physician/healthcare
professionals.
Research
The Scleroderma Foundation budgets at least $1 million a year for
research funding, its single largest budgeted expense. The Scleroderma
Foundation takes its fiduciary responsibility to donors very seriously,
especially with regard to our research grant program.
In the case of research funds, the Foundation's Peer Research
Review Committee, composed of medical experts on scleroderma from
around the world, helps determine which proposals will be funded by
reading, analyzing and ranking all proposals received. It follows a
peer review system based on that of the National Institutes of Health.
one family's story
Cheyenne Cogswell is an 8-year old third-grader living in the
poverty-stricken town of Falmouth, Kentucky. Cheyenne was diagnosed at
age six with a severe case of systemic scleroderma. The disease has
caused kidney failure and significant damage to her digestive system,
making it difficult for the body to receive the proper nutrition needed
for a growing child. She has undergone several life-saving operations
and numerous hospitalizations. Her skin and other internal organs, such
as the heart and lungs, are also affected. Cheyenne's treatment first
consisted of hospitalization and intense chemotherapy. She continues
with daily chemotherapy injections, now given by her mother, to help
suppress her immune system and slow the progression of the disease.
Cheyenne is being raised by a single mother who has faced extreme
consequences from the financial burden created by scleroderma, losing
her job in the economic downturn, as well as the family's home. Doctors
doubted if Cheyenne would survive beyond her seventh birthday, but she
continues to beat the odds. Chronic diseases like scleroderma are
unpredictable in their course, and the family--together with their
close circle of friends--continues to fight and hope for the best.
Their road is uncertain and illustrates why funding for NIH and its
research programs are vital to so many people whose lives are impacted
by chronic illness such as scleroderma.
sequestration
We have heard from the medical research community that
sequestration and deficit reduction activities have created serious
issues for Federal funding opportunities and the career development
pipeline. In order to ensure that the scleroderma research portfolio
can continue to grow, and, more importantly, to ensure that our country
is adequately preparing the next generation of young investigators, we
urge you to avert, mitigate, or otherwise eliminate the specter of
sequestration. While the Foundation has anecdotal accounts of the harms
of sequestration, the Federated American Societies for Experimental
Biology has reported:
--In constant dollars (adjusted for inflation), the NIH budget in
fiscal year 2013 was $6 billion (22.4 percent) less than it was
in fiscal year 2003.
--The number of competing research project grants (RPGs) awarded by
NIH has also fallen sharply since fiscal year 2003. In fiscal
year 2013, NIH made 8,283 RPG awards, which is 2,110 (20.3
percent) fewer than in fiscal year 2003.
--Awards for R01-equivalent grants, the primary mechanism for
supporting investigator-initiated research, suffered even
greater losses. The number awarded fell by 2,528 (34 percent)
between fiscal year 2003 and fiscal year 2013.
The pay line for some NIH funding mechanisms has fallen from 18
percent to 10 percent while the average age for a researcher to receive
their first NIH-funded grant has climbed to 42. These are strong
disincentives to choosing a career as a medical researcher. Our
scaling-back is occurring at a time when many foreign countries are
investing heavily in their biotechnology sectors. China alone plans to
dedicate $300 million to medical research over the next 5 years; this
amount is double the current NIH budget over the same period of time.
Scientific breakthroughs will continue, but America may not benefit
from the return-on-investment of a robust biotechnology sector. For the
purposes of economic and national security, as well as public health,
the Foundation asks that you work with your colleagues to eliminate
sequestration and recommit to supporting this Nation's biomedical
research enterprise.
centers for disease control and prevention
Early recognition and an accurate diagnosis of scleroderma can
improve health outcomes and save lives. CDC in general and the NCCDPHP
specifically have programs to improve public awareness of scleroderma
and other rare, life-threatening conditions. Unfortunately, budgetary
challenges at CDC have pushed the agency to focus resources on
combating a narrow set of ``winnable battles.'' Please increase funding
for CDC and NCCDPHP so that the agency can invest in additional,
critical education and awareness activities that have the potential to
improve health and save lives.
national institutes of health
NIH has worked with the Foundation to lead the effort to enhance
our scientific understanding of the mechanisms of scleroderma with the
shared-goal of improving diagnosis and treatment, and ultimately
finding a cure. Since scleroderma impacts multiple organ systems,
NIAMS, NHLBI, and NIDDK all play crucial roles in basic, translational,
and clinical research efforts. Further, emerging NIH initiatives like
the Cures Acceleration Network and the Accelerating Medicines
Partnership are creating meaningful opportunities to advance
scleroderma research. Please provide NIH with a significant funding
increase to the scleroderma research portfolio can continue to expand
and facilitate key breakthroughs.
--NHLBI, is leading Scleroderma Lung Study II, is comparing the
effectiveness of two drugs in treating pulmonary fibrosis in
scleroderma.
--NIAMS, is leading efforts to discover whether three gene expression
signatures in skin can serve as accurate biomarkers predicting
scleroderma, and investigations into progression and response
to treatment to clarify the complex interactions of T cells and
interleukin-31 (IL-31) in producing inflammation and fibrosis,
or scarring in scleroderma.
additional medical research activities
In recent years, scleroderma has been listed as a condition
eligible for study through the Department of Defense (DOD) Peer-
Reviewed Medical Research Program (PRMRP). Since fiscal year 2005, the
opportunity for scleroderma researchers to compete for funding through
this mechanism led to over $10 million in scleroderma research funding
as well as the initiation of meaningful research projects. Research on
the underlying mechanisms of scleroderma is showing relevance to all
fibrosis, which occurs at higher rates among individuals who served in
the military and our veterans. Further, military service-associated
environmental triggers, particularly silica, solvent, and radiation
exposure, are believed to be potential triggers for scleroderma in
individuals that are genetically predisposed to it.
Despite the connection between military service and scleroderma,
the condition was left off the PRMRP's eligible conditions list in
fiscal year 2014. While we appreciate that the Defense Appropriations
Subcommittee and the Senate play important roles in crafting the annual
eligible conditions list, the scleroderma community urges you to weigh
in with your colleagues on the Appropriations Committee to actively
work to see that scleroderma is re-listed as a condition eligible for
study through the PRMRP within the Committee Report accompanying the
fiscal year 2015 Defense Appropriations Bill.
Thank you again for your time and your consideration of the
scleroderma community's requests.
______
Prepared Statement of the Senior Service America, Inc.
This statement concerns the Administration's proposed fiscal year
2015 appropriations of $380 million for the Department of Health and
Human Services--Administration for Community Living's Senior Community
Service Employment Program. We urge that funding for this program be
increased to $600 million, returning the program to its funding levels
prior to the Great Recession (adjusted for inflation). This investment
would provide jobs and training for more than 30,000 additional
unemployed older Americans than the Administration's proposal. We also
urge that the Congress refer to the authorizing committee any proposals
to revise the mission of the program or transfer the program from the
Department of Labor.
The Senior Community Service Employment Program (SCSEP) is the only
Federal program targeted to provide jobs and training to low-income
older adults 55 and older. According to GAO Report GAO-11-92, SCSEP is
one of only three Federal workforce development programs that do not
overlap with any other program. Launched in 1968, SCSEP is authorized
by Title V of the Older Americans Act and is currently administered by
the Department of Labor Employment and Training Administration. In the
year ending June 30, 2013, SCSEP provided jobs and training for 67,551
economically disadvantaged older adults, who in turn provided over 37.2
million hours of staffing to 30,000 local private and private nonprofit
agencies serving the community. The value of these community service
hours was $825 million, based on hourly-wage estimates from the
Independent Sector.
The Administration's fiscal year 2015 budget proposes to cut
funding for SCSEP to $380 million, $52 million less than $432 million
in total grants awarded by the USDOL for fiscal year 2014. Senior
Service America estimates that this cut would result in 8,600 fewer
jobs and training nationwide for low income older adults and 4.4
million fewer staff hours in local agencies (whose value exceeds $97
million).
The following facts strongly support increasing the appropriations
for SCSEP in fiscal year 2015:
Low-income older workers, most of whom are long-term unemployed,
continue to suffer extremely high rates of joblessness.--As the
following table shows, since 2000 the jobless rate of low-income older
workers (55 years and older with annual family incomes less than $20k)
has been 2.5 to 3 times higher than the rate among all older workers:
----------------------------------------------------------------------------------------------------------------
Unemployment
rate for low Unemployment
Year income older rate of All
workers (%) 55+ (%)
--------------------------------------------------------------------------------------------------
2000.............................................................. 6.6 2.6
2001.............................................................. 7.6 3.0
2002.............................................................. 9.7 3.8
2003.............................................................. 11.1 4.0
2004.............................................................. 10.6 3.7
2005.............................................................. 10.1 3.4
2006.............................................................. 9.9 3.0
2007.............................................................. 10.0 3.1
2008.............................................................. 11.8 3.8
2009.............................................................. 18.8 6.6
2010.............................................................. 19.9 7.0
2011.............................................................. 19.5 6.5
2012.............................................................. 18.4 6.0
2013.............................................................. 17.0 5.8
----------------------------------------------------------------------------------------------------------------
Source: Low-income (<$20,000) age 55+ jobless rate tabulations fromCurrent Population Survey, by the Center for
Labor Market Studies,Northeastern University, for Senior Service America, Inc., January2014.
SCSEP is a unique employment and training program of the Federal
Government.--Cited in the previously mentioned 2011 GAO report as one
of only three Federal workforce programs ``that do not overlap with
other programs.'' It also assists a harder-to-serve segment of the
older adult workforce: 88 percent of participants were at or below the
poverty level; 60 percent were at least 60 years old; nearly two-thirds
were women; and over half of the participants were from a racial/ethnic
minority (PY2012).
SCSEP grantees succeed in carrying out the Congressional intent for
the program.--According to an independent national evaluation conducted
by Mathematica Policy Research (MPR) and Social Policy Research
Associates (SPR) in 2012 for the U.S. Department of Labor, ``SCSEP
projects are largely successful in recruiting and enrolling older
workers with serious barriers to employment, providing participants
with community service assignments at host agencies, and [annually]
placing nearly half of program exiters who are available for work into
unsubsidized jobs.''
Programs under the Workforce Investment Act (WIA) continue to
underserve older workers.--Several GAO reports have cited that WIA
performance measures may create disincentives for serving older workers
seeking part-time work. As a result, a disproportionately small
percentage of those served by American Job Centers are older workers.
The 2012 MPR/SPR evaluation of SCSEP stated that ``SCSEP projects find
it difficult to draw on the resources of American Job Centers to
support participants in finding jobs.''
The value of work performed by SCSEP participants in their
community service assignments is nearly double the total amount
appropriated for SCSEP.--In PY2012, SCSEP participants worked over 37
million hours at minimum wage in over 30,000 host agencies (nonprofit,
faith-based, and public), including more than 10 million hours serving
other older persons through Meals on Wheels, area agencies on aging,
and other organizations. Using the Independent Sector's estimated
hourly value of volunteer work, the estimated value of this community
service was nearly $825 million.
The fiscal year 2015 budget proposes to cut SCSEP funding to 66
percent of the 2008 level (in constant 2000 dollars), yet low-income
older workers continue to suffer from extraordinarily high rates of
unemployment.--The following graph shows the unemployment rate among
low-income older workers since 2000 (described in the previous table on
page 2) in contrast to the history of SCSEP funding, in both current
dollars and constant 2000 dollars. In 2008, the average annual
unemployment rate for low-income older adults 55 and over was 11.8
percent and SCSEP funding was $521.6 million (unadjusted) or $417.2
million (in constant 2000 dollars). In unadjusted dollars, the proposed
fiscal year 2015 budget for SCSEP of $380 million represents 73 percent
of the 2008 funding for SCSEP, but the fiscal year 2015 budget would
cut SCSEP to only 66 percent of the 2008 funding in constant dollars--
yet the average annual unemployment rate for the SCSEP-eligible
population is about 17 percent in 2013 compared to less than 12 percent
in 2008.
The following table shows the history of SCSEP funding since 2000:
------------------------------------------------------------------------
Real value of
Final annual
Fiscal Year appropriations in appropriations in
current dollars constant dollars
(millions) (base year: 2000)
------------------------------------------------------------------------
2000.............................. 440.2 440.2
2001.............................. 440.2 428.0
2002.............................. 445.1 426.1
2003.............................. 442.3 413.9
2004.............................. 434.0 395.7
2005.............................. 436.7 385.0
2006.............................. 432.3 369.3
2007.............................. 483.6 401.6
2008.............................. 521.6 417.2
2009.............................. 691.9 558.4
2010.............................. 825.4 651.8
2011.............................. 449.1 343.8
2012.............................. 448.3 336.2
2013.............................. 424.8 313.9
2014.............................. 434.4 318.6
2015 (proposed)................... 380.0 274.6 (est)
------------------------------------------------------------------------
Note: Estimation Procedure for 2015 Constant Dollar Value (base year =
2000):
Estimated Cumulative Inflation Index (CII) for 2015 is based on
projected annual inflation rate of 1.5 percent. OMB proposed SCSEP
appropriation for fiscal year 2015 = $380m. fiscal year 2015 $380m =
$278.7m in 2014 constant dollars. The CII through 2014 = $380/$278.7 =
1.3635. Estimated CII for 2015 (based on 1.5 percent inflation rate) =
1.3635 + (1.3635 x 0.015) = 1.3840. fiscal year 2015 proposed $380m
appropriation = $380m/1.3840 = $274.57m in constant dollars (base year
2000).
The proposed fiscal year 2015 would have a damaging impact on local
communities.--As the following table shows, cuts in SCSEP funding would
harm small and large States:
--------------------------------------------------------------------------------------------------------------------------------------------------------
Total fiscal year
2014 funding Estimated funding Cut in funding in Cut in number of Cut in total hours Value of lost
awarded by USDOL in fiscal year fiscal year 2015 SCSEP participants of community hours of community
($) 2015 ($) ($) service service ($)
--------------------------------------------------------------------------------------------------------------------------------------------------------
All States and Territories...... 432,285,000 380,000,000 -52,285,000 -8,630 -4,381,000 97,000,000
Alabama......................... 8,011,355 7,042,000 -969,000 -160 -87,800 -1,900,000
Illinois........................ 16,502,969 14,507,000 -1,996,000 -330 -161,000 -3,600,000
Iowa............................ 5,430,241 4,773,000 -657,000 -110 -57,900 -1,300,000
Kansas.......................... 4,210,174 3,701,000 -509,000 -80 -43,900 -1,000,000
Maryland........................ 5,832,216 5,127,000 -705,000 -120 -62,200 -1,400,000
Mississippi..................... 5,232,771 4,600,000 -633,000 -100 -53,000 -1,200,000
Tennessee....................... 8,660,178 7,613,000 -1,047,000 -170 -93,000 -2,100,000
Washington...................... 6,489,633 5,705,000 -785,000 -130 -54,900 -1,200,000
--------------------------------------------------------------------------------------------------------------------------------------------------------
In summary, our economy continues to leave millions of low-income
older Americans behind. These older workers help expand the capacity of
local agencies to meet the basic needs of their communities. In an
independent national survey of 10,000 of these agencies, 75 percent
reported that SCSEP significantly or somewhat increased their ability
to provide services. SCSEP is a unique program that achieves a wide
range of outcomes and produces multiple returns on investment.
Throughout the Nation, older Americans and communities need and depend
on the Senior Community Service Employment Program.
[This statement was submitted by Anthony R. Sarmiento, Executive
Director, Senior Service America, Inc.]
______
Prepared Statement of the Sleep Research Society
Chairman Tom Harkin, Ranking Member Jerry Moran, and distinguished
members of the Subcommittee, as you begin to craft the fiscal year 2015
Labor-HHS-Education appropriations bill, the Sleep Research Society
(SRS) is pleased to submit this statement for the record asking you to
provide $32 billion for NIH, including a proportional increase for the
National Heart, Lung, and Blood Institute (NHLBI), $1 million in
funding for sleep disorders awareness and surveillance at the Centers
for Disease Control and Prevention (CDC), full support for the National
Center on Sleep Disorders Research (NCSDR), and implementation of the
2011 NIH Sleep Disorders Research Plan. These actions will ensure
increased awareness of the importance of sleep and circadian rhythms
and further the advancements being made by sleep researchers to better
understand the relationship between sleep and health.
sleep research society
SRS was established in 1961 by a group of scientists who shared a
common goal to foster scientific investigations on all aspects of sleep
and sleep disorders. Since that time, SRS has grown into a professional
society comprising over 1,100 researchers nationwide. From promising
trainees to accomplished senior level investigators, sleep research has
expanded into areas such as psychology, neuroanatomy, pharmacology,
cardiology, immunology, metabolism, genomics, and healthy living. SRS
recognizes the importance of educating the public about the connection
between sleep and health outcomes. We promote training and education in
sleep research, public awareness, and evidence-based policy, in
addition to hosting forums for the exchange of scientific knowledge
pertaining to sleep and circadian rhythms.
According to an Institute of Medicine's report entitled, ``Sleep
Disorder and Sleep Deprivation: An Unmet Public Health Problem''
(2006), chronic sleep and circadian disturbances and disorders are a
very real and relevant issue in today's society as they affect 50-70
million Americans across all demographic groups. Sleep deprivation is a
major safety issue, particular in reference to drowsy driving, where it
is a factor in 20 percent of motor vehicle injuries. The widespread
effect of sleep disorders on every age group poses a public health
risk, extending from the ability to learn to maintain a healthy
lifestyle. Furthermore, it is important to recognize that sleep
disorders and circadian disturbances are often an indicator of, or a
precursor to other major diseases and disorders including; obesity,
diabetes, hypertension, cardiovascular disease, stroke, depression,
bipolar disorder, and substance abuse. Another increasingly detrimental
condition affecting 15 percent of the population is sleep-disordered
breathing, including obstructive sleep apnea. Sleep apnea results in
excessive daytime somnolence, poor performance, increased frequency of
road traffic accidents, and arterial hypertension. Studies show that 85
percent of 725 troops returning home from Afghanistan and Iraq had a
sleep disorder and the most common was obstructive sleep apnea (51
percent). If left untreated, obstructive sleep apnea has significant
negative impacts on health, including early mortality.
national institutes of health
Due to the fact that sleep is a multi-disciplinary issue, many
institutes and centers at NIH, utilize a portion of their funding to
support sleep and circadian research. The majority of sleep research is
coordinated by NHLBI, particularly the National Center on Sleep
Disorders Research. An appropriation of $32 billion for NIH, and $3
billion for NHLBI, is needed to facilitate the continued growth and
advancement in the sleep and circadian research portfolio.
The reason NCSDR is housed at NHLBI is due to the important link
between sleep disorders and cardiovascular health. NCSDR supports
research, health education, and research training related to sleep-
disordered breathing and the fundamental function of sleep and
circadian rhythms. Furthermore, NCSDR coordinates sleep research across
NIH and with other Federal agencies and outside organizations.
NCSDR's coordinating role between institutes is made possible
through adequate funding. These research activities also have far
reaching effects, beginning with training grants targeted towards
undergraduate students and career development opportunities attracting
top talent in doctoral programs. Sequestration has the potential to
disrupt the research training pipeline by reducing the amount of K, T,
and F series awards for new investigators. It could also disrupt the
career development pipeline designed to train future investigators who
are pursuing research in sleep disorders and circadian rhythms. It is
important to fund NIH at $32 billion and NHLBI at $3 billion in fiscal
year 2015 so that we can continue these advancements in sleep and
circadian research.
department of veterans affairs & department of defense research
activities
It is also important to recognize that by increasing the Federal
commitment to sleep and circadian research, we can improve the health
of those brave Americans who have served in uniform and are suffering
from sleep disorders. Both obstructive sleep apnea and insomnia have a
high prevalence among active-duty U.S. Armed Forces and among Veterans.
Post-traumatic stress disorder and/or depression are highly prevalent
in returning Iraq and Afghanistan combat Veterans. Sleep disturbance is
a prominent symptom in these disorders. Traumatic brain injury is
increasingly common in modern combat, and sleep disruption in the
aftermath of TBI may have negative effects on long-term recovery of
normal brain function.
The Department of Veterans Affairs (VA) and the Department of
Defense have shown a commitment to collaborating with NIH on sleep
research related to Post-Traumatic Stress Disorder (PTSD), Traumatic
Brain Injury (TBI), and Gulf War Illness (GWI). This is highlighted in
the fiscal year 2014 president's budget request detailing research
initiatives in PTSD and TBI. The ``Longitudinal Health Study of Gulf
War Era Veterans'' is one of the largest scientific research studies on
chronic diseases and multi-symptom illnesses, including Gulf War
Illness. Researchers found that prazosin, an inexpensive drug already
used by millions of Americans for hypertension and prostate problems,
improves sleep and reduces nightmares for veterans with PTSD. They
continue to pursue activities such as the difference between female and
male veterans with PTSD and possible intervention strategies to help
veterans with TBI return to daily activities. One study described in
the Veteran's Health Administration report State of VA Research 2012,
found that 96 percent of veterans with chronic multi-symptom illnesses
experienced sleep disordered breathing. By using continuous positive
airway pressure (CPAP) these veterans reported reductions in pain and
fatigue and improvements in cognitive function.
Sleep disruption, especially insomnia, is a contributing risk
factor to the onset and severity of major mental health problems such
as depression, bipolar disorder, substance abuse, PTSD, TBI, and
suicide among the veteran population. It is important to continue
supporting the sleep research endeavors of the VA through robust
funding for the Medical and Prosthetic Research Program at $589
million.
centers for disease control and prevention
CDC gathers important data on sleep disorders through their
surveillance efforts under the Chronic Disease Prevention and Health
Promotion program. Most notably, CDC hosts a National Sleep Awareness
Roundtable (NSART) by promoting the importance of sleep through the
production of State fact sheets, updating the CDC website, and
disseminating information on sleep related topics. CDC also promotes
awareness of sleep disorders and the dangers associated with sleep
deprivation for the benefit of millions of Americans. Currently
population-based data on the prevalence of circadian disruption and its
relationship to disease risk is relatively limited. Please fund CDC at
$7.8 billion including an allocation of $1 million solely for sleep
awareness and surveillance activities within the Chronic Disease
Prevention and Health Promotion program and within NSART, so that
progress can continue in the areas of sleep disorders and disturbances,
sleep awareness, and education to the public community.
nih sleep disorders research plan
NCSDR published the NIH Sleep Disorders Research Plan in November
of 2011 highlighting the implementation of pertinent sleep research
goals to enable further advancements in the realm of sleep and
circadian rhythm disorders. A Joint Task Force between the two leading
organizations representing the sleep medicine and research community,
Sleep Research Society (SRS) and American Academy of Sleep Medicine
(AASM), has identified research opportunities that will have the
highest impact on health within the plan.
The Plan recommends implementation of the following sleep research
goals which will help us understand the function of sleep and inform
individuals on healthier lifestyle choices:
--Advance the understanding of sleep and circadian functions and of
basic sleep and circadian mechanisms, in both the brain and the
body, across the lifespan.
--Identify genetic, pathophysiological, environmental, cultural,
lifestyle factors, and sex and gender differences contributing
to the risk of sleep and circadian disorders and disturbances,
and their role in the development and pathogenesis of co-morbid
diseases and disability.
--Improve prevention, diagnosis, and treatment of sleep and circadian
disorders, chronic sleep deficiency, and circadian disruption,
and evaluate the resulting impact on human health.
--Enhance the translation and dissemination of sleep and circadian
research findings and concepts to improve healthcare, inform
public policy, and increase community awareness to enhance
human health.
--Enable sleep and circadian research training to inform science in
cross-cutting domains, accelerate the pace of discovery, and
the translation of enhanced therapies from bench to bedside to
community.
Research activities and stakeholders addressed by the plan benefit
from the encompassing range of NIH research, training, and outreach
programs. Over the past 2 years, steps have been taken to implement
portions of this research plan, but additional work needs to be done.
SRS encourages you to recommend that this research plan continue to be
implemented during fiscal year 2015.
Thank you for the opportunity to submit the views of the sleep
research community. Please do not hesitate to contact us should you
have any questions or require additional information.
[This statement was submitted by Dr. Janet Mullington, Ph.D.,
President, Sleep Research Society.]
______
Prepared Statement of The Society for Healthcare Epidemiology of
America and the Association for Professionals in Infection Control and
Epidemiology
The Society for Healthcare Epidemiology of America (SHEA) and the
Association for Professionals in Infection Control and Epidemiology
(APIC) thank you for this opportunity to submit testimony on Federal
efforts to detect dangerous infectious diseases, protect the American
public from preventable healthcare-associated infections (HAIs) and
address the rapidly growing threat of antibiotic resistance (AR). We
ask that you support the following programs: First, under the Centers
for Disease Control and Prevention National Center for Emerging and
Zoonotic Infectious Diseases: $250 million for Core Infectious Diseases
including $30 million for the new Detect and Protect Against Antibiotic
Resistance (AR) Initiative, $32 million for the National Healthcare
Safety Network (NHSN), and $30 million for the Advanced Molecular
Detection (AMD) Initiative. Additionally, we request $34 million for
HAI research activity conducted by the Agency for Healthcare Research
and Quality (AHRQ) and $4.58 billion for the National Institutes of
Health/National Institute of Allergy and Infectious Diseases (NIAID).
HAIs are among the leading causes of preventable death in the
United States. In hospitals alone, CDC estimates that one in 25
patients has an HAI, totaling approximately 722,000 infections in 2011.
According to the CDC, every day, more than 200 Americans with HAIs will
die during their hospital stay. Further, AR is one of the most critical
public health and patient safety threats facing us today, causing an
estimated two million illnesses and approximately 23,000 deaths
annually. It is estimated that as much as half of antibiotic
prescribing in hospitals is not necessary. Antibiotics, created to save
lives, are now contributing to patient's deaths by promoting the
emergence of highly resistant bacteria and leading to deadly adverse
events.
Centers for Disease Control and Prevention (CDC)
We urge you to support the CDC Coalition's request for $7.8 billion
in fiscal year 2015 for the CDC's ``core programs.'' We are concerned
that the President's fiscal year 2015 budget proposal would reduce the
CDC's budget authority by $243 million when compared with fiscal year
2014. This total is, in fact, lower than 2003 levels. We urge Congress
to prioritize funding for the activities and programs supported by CDC
that are essential to protect the health of the American people and
reduce healthcare costs.
We especially want to highlight our support for the $30 million in
the President's budget for the Detect and Protect Against Antibiotic
Resistance (AR) Initiative. This initiative will establish a robust
network of five regional labs that will detect the deadliest AR threats
and protect patients and communities through the rapid identification
of outbreaks, saving lives and reducing healthcare costs. It will
prioritize healthcare prevention collaboratives focused on improving
antibiotic use and preventing deadly infections caused by Clostridium
difficile (C. diff), carbapenem-resistant Enterobacteriaceae (CRE),
Pseudomonas, and methicillin-resistant Staphylococcus aureus (MRSA).
Most importantly, the initiative will invest in direct action by
implementing proven evidence-based interventions that reduce the
emergence and spread of AR pathogens and improve antibiotic use. It is
critical that Congress prioritize this rapidly growing threat to public
health and patient safety in our Nation and around the world. Moreover,
we strongly support CDC's focus on the implementation of antimicrobial
stewardship programs in all healthcare settings.
We urge you to support the $32 million in the President's budget
for the CDC's National Healthcare Safety Network (NHSN). The
President's request represents a $14 million increase over the fiscal
year 2014 enacted level for the NHSN to extend HAI prevention efforts
to more than 3,000 ambulatory surgery centers and other non-hospital
settings. This will enable CDC to conduct applied research on
interventions for infection prevention and continue to provide data for
national HAI elimination and targeted HAI prevention intervention. This
funding level will also allow for the extension and implementation of
the NHSN Antimicrobial Use and Resistance Components to enable rapid
detection of highly resistant pathogens and track antibiotic use in
healthcare settings.
The NHSN serves as the foundation for the development of
innovative, evidence-based HAI prevention strategies through high-
quality monitoring of HAI prevalence as well as antibiotic usage in the
US. It is a critical tool used by healthcare facilities to monitor and
prevent HAIs. The NHSN provides medical facilities, states, regions,
and the Nation with data collection and reporting capabilities needed
to comply with state and Federal public reporting mandates, including
the Centers for Medicare & Medicaid Services' Value-Based Purchasing
Program. Consistent, scientifically sound and validated data are
necessary to be reported at the state and Federal levels to ensure that
accurate data are available to evaluate progress related to the HHS
National Action Plan to Prevent HAIs as well as to support transparency
to the public, allowing for fair comparisons between facilities.
By August 2013, over 12,400 healthcare facilities, including nearly
all U.S. hospitals, participated in NHSN for quality improvement. The
number of acute care hospitals reporting multi-drug resistant organisms
(such as C.diff and MRSA) through NHSN more than doubled to 4,000 in
fiscal year 2013. Since 2008, the cumulative impact of CDC data
systems, guidelines and programs has contributed to significant
reductions of HAIs in healthcare settings, including a 44 percent
reduction in central line-associated bloodstream infections, a 31
percent reduction in healthcare-associated invasive MRSA infections,
and a 20 percent reduction in surgical site infections.
We strongly support the CDC Prevention Epicenters Program. Funded
through the NHSN, this program is a collaboration between CDC and
academic medical centers that conduct innovative infection control and
prevention research to address important scientific questions regarding
the prevention of HAIs, antibiotic resistance and other adverse
healthcare events. The Epicenters Program has provided a unique forum
in which academic leaders in healthcare epidemiology can partner
directly with each other and with CDC subject matter experts. The
resultant emphasis on multicenter collaborative research projects,
through which investigators work together as a group, allows for
research that in many cases, would not have been possible for a single
academic center. Going forward, the Prevention Epicenters will continue
to address gaps and pilot innovative ways to prevent HAIs and
antimicrobial resistance.
We urge your continued support of the President's $30 million
request for the Advanced Molecular Detection (AMD) Initiative in
bioinformatics and genomics, which allows CDC to more quickly determine
where emerging diseases come from, whether microbes are resistant, and
how microbes are moving through a population. This Initiative is
critical because it strengthens CDC's epidemiologic and laboratory
expertise to effectively guide public health action.
We strongly support the critical work conducted through the
Emerging Infections Program (EIP), which engages a network of state
health departments and their academic medical center partners to help
answer important questions about emerging HAI threats, advanced
infection tracking methods and antibiotic resistance in the U.S.
Agency for Healthcare Research and Quality
We request your support of the proposed investment of $34 million
for AHRQ's HAI research activity, the level of enacted support in
fiscal year 2014. Building on the successes of fiscal year 2013 and
2014, these funds will support a portfolio of grant- and contract-
funded projects seeking to advance our knowledge about effective
approaches to reducing HAIs while promoting the implementation of
proven methods for preventing HAIs. These grants ($13.9 million) and
contracts ($20.1 million) will investigate methods of controlling HAIs
in diverse healthcare settings and will address the major types of
HAIs. In addition, contracts funded by the HAI budget will accelerate
the nationwide implementation of the Comprehensive Unit-based Safety
Program (CUSP). To date, widespread adoption of this evidence-based
checklist of safety practices to over 1,000 intensive care units has
reduced the incidence of central line-associated bloodstream infections
(CLABSIs) by 41 percent. Our organizations are pleased to participate
in the On the CUSP: Stop CAUTI initiative, which aims to reduce mean
rates of CAUTI in U.S. hospitals by 25 percent by working with state
organizations and hospitals across the country to implement the CUSP
and catheter-associated urinary tract infection (CAUTI) reduction
practices in hospital units. In spite of notable progress, there
remains work to be done toward the goal of HAI elimination.
National Institutes of Health (NIH)/National Institute of Allergy and
Infectious Diseases (NIAID)
Within NIH, we believe that the National Institute of Allergy and
Infectious Diseases (NIAID) should be funded at least at the $4.58
billion requested by the Administration in the fiscal year 2014 budget
request. Nearly flat-funding NIAID limits investment in new research
and serves as a disincentive for young people to pursue infectious
disease research careers so critical to the discovery of new therapies,
new diagnostic approaches, and new preventive strategies.
In 2013, the NIAID began funding a new clinical trials network
focused on antibiotic-resistant bacterial infections. With sufficient
funding, the new research network/infrastructure will conduct studies
to address antibiotic resistance as well as begin to answer questions
that will help fill the nearly empty antibiotic research and
development pipeline. Severe economic disincentives have caused a mass
exodus of private companies from the antibiotics market, making
federally funded research in this area more critical than ever. We
applaud NIAID's initiative in launching the new network. We recommend
increased investment in this area.
We thank you for the opportunity to submit testimony and greatly
appreciate your leadership in the effort to eliminate preventable HAIs
and combat antibiotic resistance.
Please forward questions to:
Melanie Young, Policy & Strategic Initiatives Director, SHEA,
myoung@shea-online.org and Lisa Tomlinson, Senior Director, Government
Affairs, APIC, ltomlinson@apic.org.
______
Prepared Statement of the Society for Neuroscience
Mr. Chairman and members of the Subcommittee, my name is Carol Ann
Mason, Ph.D. I am a professor of pathology and cell biology,
neuroscience, and ophthalmic science at Columbia University. I study
the development of visual pathways in mammalian brains, with a focus on
how neurons in the eye are encoded to project to the correct side of
the brain, setting up the circuit for binocular vision. This statement
is in support of increased funding for NIH for fiscal year 2015.
I am pleased to submit this testimony in my capacity as president
of the Society for Neuroscience (SfN). On behalf of the nearly 40,000
members of SfN, thank you for your past support of neuroscience
research at NIH. SfN's mission is to advance the understanding of the
brain and nervous system; provide professional development activities,
information and educational resources; promote public information and
general education; and inform legislators and other policymakers.
The Society stands with others in the research community in
requesting at least $32 billion for NIH for fiscal year 2015.
Sequestration is taking an enormous toll on biomedical research, coming
on top of recent years when funding has failed to keep pace with the
cost of research--let alone the scientific opportunities that are
available. SfN urges Congress to reverse the current course and find
ways to invest more in biomedical research. Let's work to put
biomedical research on a trajectory of sustained growth that recognizes
its promise and opportunity as a tool for economic growth and, more
importantly, for advancing the health of Americans.
Neuroscience: An Investment in Our Future
Even in the face of the difficult funding situation, the last
several years have been a tremendously exciting and productive time for
neuroscience discoveries. Major research advances on brain development,
imaging, genomics, circuits, computational neuroscience, neural
engineering, and many other disciplines are leading to new tools, new
knowledge, and greater understanding that were unimaginable even a few
years ago. Sustained investment to fuel and speed these discoveries is
essential to American health and economic well-being for many reasons.
First, major investment in basic and translational neuroscience is
not only fueling an enduring and vital scientific endeavor; it is the
essential foundation for understanding and treating diseases that
strike nearly 1 billion people worldwide. All told, there are more than
1,000 debilitating neurological and psychiatric diseases that strike
over 100 million Americans each year, producing inestimable hardship
for millions of America families and costing the U.S., in a
conservative estimate, at least $760 billion a year, with expenses in
the trillions looming for conditions such as Alzheimer's disease.
Advances made possible by publicly-funded basic research will help
better understand and treat traumatic brain injury, Alzheimer's,
Parkinson's disease, Down syndrome, schizophrenia, epilepsy, and post-
traumatic stress disorder, to name just a few. With so much promising
research, now, more than ever, it is time to fan the flames of research
in order to ensure lifesaving breakthroughs continue.
Additionally, NIH funding is an investment in America's current
economic strength. Funding for research supports quality jobs and
increases economic activity. NIH supports approximately 400,000 jobs
and $58 billion in economic output nationwide. Eighty-five percent of
the NIH budget fund extramural research in communities located in every
State.
Finally, without robust, sustained investment, America's status as
the preeminent leader in biomedical research is at risk. Other
countries are investing heavily in biomedical research to take
advantage of new possibilities. Even with the growing philanthropic
support, private sector cannot be expected to close the gap. The lag
time between discovery and profitability means that the pharmaceutical,
biotechnology, and medical device industries need federally-funded
basic (also known as fundamental) research to develop products and
treatments. The foundation that basic research provides is at risk if
federally-funded research declines.
The BRAIN Initiative
SfN appreciates that both Congress and the administration recognize
brain science as one of the great scientific challenges of our time.
The Brain Research through Application of Innovative Neurotechnologies
(BRAIN) Initiative--announced by the President last April--will enable
NIH and other Federal agencies to develop tools and plans that will
help accelerate fundamental discoveries and improve the health and
quality of life for millions of Americans. An eminent group of
neuroscientists with diverse research interests is helping to formulate
a scientifically-driven direction for the initiative, and SfN thanks
public leaders for their interest and early support for a truly
transformative scientific grand challenge that would need major
financial emphasis in future years.
The overarching goal of the BRAIN Initiative is to map the circuits
of the brain and the activity within those circuits to understand our
unique cognitive and behavioral capabilities. The Initiative has a
strong focus on developing technologies which has the potential to
benefit all of neuroscience and even non-neuroscience research. BRAIN,
like other major brain-related initiatives around the world,
demonstrates the global interest in tackling the mysteries of the
brain. But BRAIN--as with all the neuroscience research that takes
place with Federal support--can only be successful if it is part of a
broad neuroscience commitment across Congress and the Administration.
Such an investment will also help ensure the U.S. remains a global
leader, as other nations and regions are now rapidly ramping up their
investments in neuroscience research.
Cross-Disciplinary Neuroscience and the Promise of Brain Circuits
NIH-funded basic research continues to be essential for discoveries
that will inspire scientific and medical progress for generations. Past
NIH-supported projects have helped neuroscientists make tremendous
strides in diagnosing and treating neurological and psychiatric
disorders.
A prime example of the importance of funding research at levels
from the most basic to translational is the current focus on
understanding brain circuits. Circuits in the brain underlie every
thought, emotion, and action we take. Current knowledge about the
intricate patterns connecting brain cells is extremely limited.
Identifying these patterns is essential to understand healthy brain
function and dysfunction in injury or disease. Research suggests that
some brain disorders, like autism and schizophrenia, may result from
errors in neural circuit development. Elucidating brain circuit
structure and function is an enormously challenging endeavor; the brain
consists of billions of cells, and each cell contacts thousands of
others. These cells communicate with precisely-timed signals, which
then activate a multitude of biochemical pathways that influence every
process in the cell. However, scientists are beginning to map the
functions of brain circuits with previously unheard-of specificity
using cutting-edge technologies, and learning how these circuits
produce behaviors.
The following examples are just a few of the many basic research
success stories in the science of brain circuitry emerging now thanks
to interdisciplinary research funded by a strong historic investment in
NIH and other research agencies.
Optogenetics
Optogenetics is a technique which uses light to activate specific
populations of neurons with millisecond precision. It is difficult to
overstate how revolutionary optogenetics is for neuroscience research.
With optogenetics, flashes of light are used to activate neurons that
have been genetically modified to contain a light-sensing protein. This
precise control over specific populations of neurons at specific times
was impossible until a confluence of basic research in marine biology,
genetic engineering, cellular biology, and fiber optic technology
facilitated its development; together these developments created an
approach that enables the proteins to be used as ``on switches'' for
cells. Introduced a decade ago, optogenetics is now used by hundreds of
labs; it is one of the many neurotechnologies that today is
transforming the field's ability to understand brain function, and is
being used to study brain circuits in both normal function and disease,
including Parkinson's disease, as described below. The development of
this technology also perfectly demonstrates the often serendipitous
nature of scientific discovery and the need to fund both research on
all levels, from basic to translational to clinical.
Understanding the Development of Vision
My own area of research is the development of the circuits
underlying vision. For binocular vision to function, the brain must
receive information from both eyes. Nerve fibers from each retina grow
to the `optic chiasm,' at the midline of the bottom of the brain. Here,
nerve fibers from each eye cross to the other side of the brain. Other
axons, however, are repelled at the midline and project to the same
side of the brain. These connections underlie binocular vision which
enables animals, including humans, to calculate how far objects lie in
the distance. One area of my research focuses on this question and the
molecular mechanisms that prompt some growing nerve fibers to ``stop in
their tracks'' and reroute to the same side. These two groups of cells
in the eye, each taking different routes, are endowed with distinct
genes that direct their time of birth and their growth to the regions
where they make their synaptic connections. Understanding their genetic
``signatures'' and growth helps us to learn how to encourage stem cells
to be integrated into the diseased eye and injured nerve fibers to
regrow in the correct circuits. We also investigate how the retinal
pigment epithelium (RPE) surrounding the eye, directs retinal
development. Perturbations in the RPE occur in albinism and in juvenile
forms of macular degeneration, the latter leading to blindness, and our
gene identification efforts are important for gene therapy at early
stages of the disease. Moreover, understanding how tracts are laid down
is essential for unraveling the basis of defects in fiber pathways and
synapse formation in neurodevelopmental disorders such as autism. This
research is made possible with support primarily from NIH, especially
the National Eye Institute and with a team of innovative and
collaborative scientists and trainees in my lab and in our community,
and provides a foundation for future discovery and new understanding
about diseases of the eye and other neurodevelopmental conditions.
Deep Brain Stimulation
Deep brain stimulation (DBS) is a tool that emerged as a result of
advances in health research. DBS involves a surgical procedure in which
a neurostimulator device--similar to a heart pacemaker--is implanted to
deliver electrical stimulation to targeted areas in the brain. While
both DBS and optogenetics have emerged as instrumental methods to
influence circuits, DBS has also been developed into a revolutionary
therapy for the treatment of neurological disease. The electrical
pulses delivered through the electrodes can transiently disrupt
abnormal activity that occurs in localized circuits of diseased brains,
such as in Parkinson's patients.
DBS has created a new way to approach the treatment of Parkinson's
disease. Many patients experience pronounced relief from symptoms that
include tremor, stiffness, slowed movement, and walking problems.
Moreover, DBS can allow patients to reduce the dosage of their
medication, providing relief from debilitating motor side-effects.
Additionally, advances in materials science to create more flexible
electrodes and in imaging research to produce higher resolution images
of the brain will improve the precision and outcome of this
intervention.
At this time, how and why DBS works is unknown. Insight into its
mechanism of action came from optogenetic studies in rodents of the
brain circuits that control movement. By systematically manipulating
precise areas of the circuit affected by this disease, scientists were
able to implicate the connection between two areas of the brain as the
most effective target for DBS. These studies will also inform the
design of other interventions in Parkinson's, and establish a model for
study of basic brain circuitry to inform DBS treatment.
DBS has also had success in treating both intractable depression
and epilepsy, and has the potential to improve therapies for a whole
host of brain diseases and disorders--as long as the correct target is
identified. Because stimulating adjacent regions in the brain can have
vastly different effects, researchers are attempting to better
understand the complex brain circuits that control our normal functions
(e.g., movement, emotion) and how they can go wrong (e.g., addiction).
They also are tweaking the physical devices used, as well as the
frequency and strength of the electrical pulses delivered. As we
understand more about language of the brain through the research made
possible by NIH funding, new applications of DBS will be possible.
The Future of American Science
As the subcommittee considers this year's funding levels, please
consider that significant advancements in the biomedical sciences often
come from young investigators. As a director of the PhD training
program of a leading neuroscience department, I see firsthand that the
current funding environment is taking a toll on the energy and
resilience of these young people and their career choice. America's
scientific enterprise--and its global leadership--has been built over
generations. Without sustained, consistent investment, we will quickly
lose that leadership. Dramatic swings in funding have stifling and
irreversible impacts on progress; a closed laboratory can't simply open
again when funding is restored. The culture of entrepreneurship and
curiosity-driven research could be hindered for decades.
We live at a time of extraordinary opportunity in neuroscience. A
myriad of questions once impossible to consider are now within reach
because of new technologies, an ever-expanding knowledge base, and a
willingness to embrace many disciplines. To take advantage of the
opportunities in neuroscience we need an NIH appropriation that allows
for sustained, reliable growth. That, in turn, will lead to improved
health for the American public and will help maintain American
leadership in science worldwide. Thank you for this opportunity to
testify.
[This statement was submitted by Carol Ann Mason, Ph.D., President,
Society for Neuroscience.]
______
Prepared Statement of The Society for Public Health Education
I am pleased to submit this testimony on behalf of The Society for
Public Health Education (SOPHE), a 501 (c)(3) professional organization
founded in 1950 to provide global leadership to the profession of
health education and health promotion. SOPHE's 4,000 national and
chapter members work in universities, medical/healthcare settings,
businesses, voluntary health agencies, international organizations, and
all branches of Federal/State/local government. Members include
behavioral scientists, faculty, practitioners, and students engaged in
disease prevention and health promotion in both the public and private
sectors. The Society contributes to the health of all people and the
elimination of health disparities through advances in health education
theory and research; excellence in professional preparation and
practice; and advocacy for public policies conducive to health. SOPHE
is the only independent professional organization devoted exclusively
to health education and health promotion. SOPHE's two scientific peer-
reviewed journals, electronic newsletters, listservs, websites, new
Center for Online Education (CORE), as well as its national conference
help ensure that vital public health activities and programs in various
regions are expeditiously disseminated. There are currently 20 SOPHE
chapters covering more than 30 States and regions across the country.
SOPHE's vision of a healthy world through health education compels
us to advocate for increased resources targeted at the most pressing
public health issues. For the fiscal year 2015 funding cycle, SOPHE
encourages the Labor, Health and Human Services, Education and Related
Agencies (Labor-HHS) Subcommittee to increase funding for public health
programs that focus on preventing chronic disease and other illnesses
in adults as well as youth, and eliminating health disparities. In
particular, SOPHE requests the following fiscal year 2015 funding
levels for Labor-HHS programs:
--$7.8 billion for the U.S. Centers for Disease Control and
Prevention (CDC)
-- $1.1 billion for the CDC National Center for Chronic Disease
Prevention and Health Promotion (NCCDPHP)
-- $25 million for CDC's National Chronic Disease Prevention and
Health Promotion's Division of Population Health School
Health Program
-- $1 billion for the Prevention and Public Health Fund
-- $80 million for Community Prevention Grants
-- $50 million for Racial and Ethnic Approaches to Community
Health
The discipline of health education and health promotion, which is
some 100 years old, uses sound science to plan, implement, and evaluate
interventions that enable individuals, groups, and communities to
achieve personal, environmental and population health. Beyond
supporting individual behavior change, health education focuses on
policy, systems, and environmental changes to support a healthy
lifestyle. There is a robust, scientific evidence-base documenting not
only that health education specialists and their various health
education interventions work, but that they are also cost-effective.
These principles serve as the basis for our support for the programs
outlined below and can help ensure our Nation's resources are targeted
for the best return on investment. Our profession is the first to
recruit and train community health workers in terms of cost-effective
program interventions.
SOPHE is requesting a fiscal year 2015 funding level $7.8 billion
for CDC in order to prevent chronic diseases and other illnesses,
promote health, prevent injury and disability, and ensure preparedness
against health threats. Unfortunately, President Obama's fiscal year
2015 budget request of $6.6 billion for CDC represents a decrease of
some $243 million when compared with fiscal year 2014. CDC is at the
forefront of U.S. efforts to monitor health, detect and investigate
health problems, conduct research to enhance prevention, develop sound
public health policies, and foster safe and healthful environments.
More than 80 percent of all CDC funds go back to States to address
State and local health issues. Measured investments now in community-
led, evidence-based innovative programs will help to increase our
Nation's productivity and performance in the global market; help ensure
military readiness; decrease costly deaths due to infant low birth
weight and adult onset of cancer, cardiovascular disease, diabetes, and
HIV/AIDS, and; increase pediatric and adult immunization rates.
Moroever, cuts to CDC's budget are not sustainable and will reduce the
ability to investigate and respond to public health emergencies as well
as foodborne and infectious disease outbreaks.
Preventing Chronic Disease
The data are clear: chronic diseases are the Nation's leading
causes of morbidity and mortality and account for 75 percent of every
dollar spent on healthcare in the U.S. Collectively, they account for
70 percent of all deaths nationwide. Healthcare accounts for 18 percent
of GDP, and it is expected to account for 19.6 percent by 2021. Yet
evidence shows that investing just $1 in preventing chronic disease
will yield a $5 return on investment.
SOPHE requests an appropriation of $1.1 billion for the CDC's
National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP). For example, heart conditions cost the Nation more than $107
billion annually in healthcare costs, and nearly $95 billion in lost
economic productivity. Studies show that spending as little as $10 per
person on proven preventive interventions could save the country over
$16 billion in just 5 years. The public overwhelmingly supports
increased funding for disease prevention and health promotion programs.
Among the many vital programs in CDC's NCCDPHP, SOPHE is requesting
a fiscal year 2015 funding level of $25 million to the CDC Division of
Population Health's School Health Branch (SHB). The increase in funding
will allow the SHB to create a coordinated, national response to school
health and chronic disease, which will maximize program effectiveness
and accelerate health improvements. School health activities supported
through the SHB include: supporting healthier nutrition environments in
schools; providing comprehensive school physical activity programs and
multi-component physical education policies; and improving capacity to
manage chronic conditions. Almost 80 percent of young people do not eat
the recommended five servings of fruits and vegetables each day. Daily
participation in high school physical education classes dropped from 42
percent in 1991 to 32 percent in 2001. Health and fitness are linked to
improved academic achievement and grades, cognitive ability, and
behavior as well as reduced truancy.
Since fiscal year 2012, funding for CDC's school health activities
to prevent chronic diseases has essentially been level funded at $14.9
million. DPH provides a basic level of funding for school health
activities in all 50 States (about $75,000 per State). This small
amount of funding allows States to only conduct a minimum of school-
based health activities. The School Health Branch also provides an
enhanced level of funding on a competitive basis to a smaller number of
States. Increasing resources for the SHB will enable all 50 States and
DC to engage in enhanced school health activities that improve the
school nutrition environment and increase the quality and quantity of
physical education and physical activity opportunities. States would
also be strongly encouraged to fund a school health position at the
State education agency to coordinate efforts with the State health
department. CDC's Coordinated School Health Programs are cost-effective
in improving children's health, their behavior, and their academic
success. This funding builds bridges between State education and public
health departments to coordinate health education, nutritious meals,
physical education, mental health counseling, health services, healthy
school environments, and parent and community involvement. The 2013 IOM
report Educating the Student Body: Taking Physical Activity and
Physical Education to School, stated that the school environment is key
in encouraging and providing opportunities for children and adolescents
to be active. The lack of physically fit and health-literate graduates
has become a national security issue--being overweight or obese has
become the leading medical reason why applicants fail to qualify for
military service.
An Avenue to Future Health Savings
SOPHE is requesting a fiscal year 2015 funding level of $1 billion
for the Prevention and Public Health Fund. We applaud Congress for
appropriating the Fund for the first time, as was intended by the law
since the Fund's inception, in the fiscal year 2014 omnibus bill. We
strongly encourage Congress to continue to appropriate the Fund at this
level in fiscal year 2015 to sustain essential core public health
infrastructure, the workforce, and our capacity to improve health in
our communities. This fund provides the agility for innovation and
meeting the needs of communities at the State and local levels.
Specifically, the Prevention Fund helps States tackle the leading
causes of death and root causes of costly, preventable chronic disease;
detect and respond rapidly to health security threats; and prevent
accidents and injuries. With this investment, the Fund helps States and
the Nation as a whole focus on fighting disease and illness before they
happen. The evidence is overwhelming: investing in prevention saves
lives and money. A 2011 Urban Institute study concluded that it is in
the Nation's best interest from both a health and economic standpoint
to maintain funding for evidence-based, public health programs that
save lives and bring down costs; a July 2011 study published in the
journal Health Affairs found that increased spending by local public
health departments can save lives currently lost to preventable
illnesses; and a follow up to that study in 2013 found that low-income
communities experience the largest health and economic gains with
respect to increases in local public health spending. In addition,
lower death rates and healthcare costs were seen especially in
communities that allocated their public health funding across a broader
mix of preventive services.
SOPHE supports the new Community Prevention Grant program that will
be funded at $80 million to help communities build multi-sector
partnerships to strengthen multisector partnerships aimed at better
health. Although SOPHE is disappointed that the Community
Transformation Grant (CTG) program was discontinued in the fiscal year
2014 omnibus, we look forward to a new stream of funding that will
support communities to implement evidence-based chronic disease
prevention strategies. SOPHE has met with key stakeholders in both
Congress and the Administration and looks forward to realizing the
vision of forthcoming funding opportunity announcements.
As part of the Prevention Fund, SOPHE strongly supports the
increase in funding CDC's Racial and Ethnic Approaches to Community
Health Across the U.S. (REACH U.S.) program, which addresses health
risk behaviors in both children and adults. Chronic diseases account
for the largest health gap among populations and increase health
disparities among racial and ethnic minority groups. As the U.S.
population becomes increasingly diverse, the Nation's health status
will be heavily influenced by the morbidity of racial and ethnic
minority communities. With additional funding from the Prevention and
Public Health Fund, the REACH program will address strategies in the
areas of tobacco-free living, active living and healthy eating,
clinical and other preventive services, social and emotional wellness,
and healthy and safe physical environments--with a primary focus on
African-American/Black, Hispanic/Latino, Asian, Native Hawaiian/Pacific
Islander, and American Indian/Alaskan Native populations. These
culturally sensitive, population specific programs, often led by health
education specialists in tandem with community health workers, are
aimed at disease risk reduction and preventing costly hospital re-
admission rates.
Thank you for this opportunity to present our views to the
Subcommittee. We understand there will be difficult choices to make in
this fiscal environment, and join you in seriously evaluating how our
Nation's scarce resources can provide maximum return on investment.
Public health funding gets the job done at the State and local levels
and only represents 1.5 percent of Federal budget; lack of full funding
would only be ``penny wise and pound foolish''.
SOPHE shares the Subcommittee's goals to support the Nation's
efforts to thrive and grow through sound investments in labor,
education and health. This can only be accomplished with a healthy
population contributing to a skilled, healthy and productive workforce.
We look forward to working with you to prevent chronic illness, improve
the quality of lives, and save billions of dollars in healthcare
spending.
[This statement was submitted by M. Elaine Auld, MPH, MCHES, Chief
Executive Officer, Society for Public Health Education.]
______
Prepared Statement of the Society for Public Health Education
The Society for Public Health Education (SOPHE) is a 501 (c)(3)
professional organization founded in 1950 to provide global leadership
to the profession of health education and health promotion. SOPHE
contributes to the health of all people and the elimination of health
disparities through advances in health education theory and research;
excellence in professional preparation and practice; and advocacy for
public policies conducive to health. SOPHE is the only independent
professional organization devoted exclusively to health education and
health promotion. SOPHE's two scientific peer-reviewed journals,
electronic newsletters, listservs, websites, new Center for Online
Education (CORE), as well as its national conference help ensure that
vital public health activities and programs in various regions are
expeditiously disseminated. Members include behavioral scientists,
faculty, practitioners, and students engaged in disease prevention and
health promotion in both the public and private sectors. Collectively,
SOPHE's 4,000 national and chapter members work in universities,
medical/healthcare settings, businesses, voluntary health agencies,
international organizations, and all branches of Federal/State/local
government. There are currently 20 SOPHE chapters covering more than 30
States and regions across the country.
SOPHE's vision of a healthy world through health education compels
us to advocate for increased resources targeted at the most pressing
public health issues. For the fiscal year 2015 funding cycle, SOPHE
encourages the Labor, Health and Human Services, Education and Related
Agencies (Labor-HHS) Subcommittee to increase funding for public health
programs that focus on preventing chronic disease and other illnesses
in adults as well as youth, and eliminating health disparities. In
particular, SOPHE requests the following fiscal year 2015 funding
levels for Labor-HHS programs:
--$7.8 billion for the Centers for Disease Control and Prevention
(CDC)
--$1 billion for the Prevention and Public Health Fund
--$50 million for Racial and Ethnic Approaches to Community Health
--$80 million for Community Prevention Grants
--$25 million for CDC's Division of Population Health School Health
Program
The discipline of health education and health promotion, which is
some 100 years old, uses sound science to plan, implement, and evaluate
interventions that enable individuals, groups, and communities to
achieve personal, environmental and population health. There is a
robust, scientific evidence-base documenting not only that various
health education interventions work but that they are also cost-
effective. These principles serve as the basis for our support for the
programs outlined below and can help ensure our Nation's resources are
targeted for the best return on investment.
Preventing Chronic Disease
The data are clear: chronic diseases are the Nation's leading
causes of morbidity and mortality and account for 75 percent of every
dollar spent on healthcare in the U.S. Collectively, they account for
70 percent of all deaths nationwide. Healthcare now accounts for 18
percent of GDP, and it's expected to account for 19.6 percent by 2021.
Yet evidence shows that investing just $1 in preventing disease will
yield a $5 return on investment.
SOPHE is requesting a fiscal year 2015 funding level $7.8 billion
for CDC in order to prevent chronic diseases and other illnesses,
promote health, prevent injury and disability, and ensure preparedness
against health threats. Unfortunately President Obama's fiscal year
2015 budget request of $6.6 billion for CDC represents a nearly $243
million reduction when compared with fiscal year 2014. CDC is at the
forefront of U.S. efforts to monitor health, detect and investigate
health problems, conduct research to enhance prevention, develop sound
public health policies, and foster safe and healthful environments.
More than 80 percent of all CDC funds go back to States to address
State and local health issues. Studies show that spending as little as
$10 per person on proven preventive interventions could save the
country over $16 billion in just 5 years. The public overwhelmingly
supports increased funding for disease prevention and health promotion
programs. Small investments now in community-led, innovative programs
will help to increase our Nation's productivity and performance in the
global market; help ensure military readiness; decrease rates of infant
mortality, deaths due to cancer, cardiovascular disease, diabetes, and
HIV/AIDS, and; increase immunization rates. Cuts to CDC's budget are
not sustainable and will reduce the ability to investigate and respond
to public health emergencies as well as foodborne and infectious
disease outbreaks.
SOPHE is requesting a fiscal year 2015 funding level of $1 billion
for the Prevention and Public Health Fund. We applaud Congress for
appropriating the Fund for the first time, as was intended by the law
since the Fund's inception, in the fiscal year 2014 omnibus bill. We
strongly encourage Congress to continue to appropriate the Fund at this
level in fiscal year 2015 to sustain essential core public health
infrastructure, the workforce, and our capacity to improve health in
our communities. The Prevention Fund helps States tackle the leading
causes of death and root causes of costly, preventable chronic disease;
detect and respond rapidly to health security threats; and prevent
accidents and injuries. With this investment, the Fund helps States and
the Nation as a whole focus on fighting disease and illness before they
happen. The evidence is overwhelming: investing in prevention saves
lives and money. A 2011 Urban Institute study concluded that it is in
the Nation's best interest from both a health and economic standpoint
to maintain funding for evidence-based, public health programs that
save lives and bring down costs; a July 2011 study published in the
journal Health Affairs found that increased spending by local public
health departments can save lives currently lost to preventable
illnesses; and a follow up to that study in 2013 found that low-income
communities experience the largest health and economic gains with
respect to increases in local public health spending. In addition,
lower death rates and healthcare costs were seen especially in
communities that allocated their public health funding across a broader
mix of preventive services.
SOPHE strongly supports the increase in funding CDC's Racial and
Ethnic Approaches to Community Health Across the U.S. (REACH U.S.)
program, which addresses health risk behaviors in both children and
adults. Chronic diseases account for the largest health gap among
populations and increase health disparities among racial and ethnic
minority groups. As the U.S. population becomes increasingly diverse,
the Nation's health status will be heavily influenced by the morbidity
of racial and ethnic minority communities. With additional funding from
the Prevention and Public Health Fund, the REACH program will address
strategies in the areas of tobacco-free living, active living and
healthy eating, clinical and other preventive services, social and
emotional wellness, and healthy and safe physical environments--with a
primary focus on African-American/Black, Hispanic/Latino, Asian, Native
Hawaiian/Pacific Islander, and American Indian/Alaskan Native
populations.
SOPHE supports the new Community Prevention Grant program that will
be funded at $80 million to help communities build multi-sector
partnerships around better health. While SOPHE is disappointed that the
Community Transformation Grant (CTG) program was discontinued in the
fiscal year 2014 omnibus, we look forward to a new stream of funding
that will support communities to implement evidence-based chronic
disease prevention strategies. SOPHE looks forward to working with the
Administration on forthcoming funding opportunity announcements.
SOPHE is requesting a fiscal year 2015 funding level of $25 million
to CDC's Division of Population Health's School Health Branch (SHB).
The increase in funding will allow the SHB to create a coordinated,
national response to school health and chronic disease, maximizing
program effectiveness, and accelerating health improvements. School
health activities supported through the SHB include: supporting
healthier nutrition environments in schools; providing comprehensive
school physical activity programs and multi-component physical
education policies; and improving capacity to manage chronic
conditions. Almost 80 percent of young people do not eat the
recommended five servings of fruits and vegetables each day. Daily
participation in high school physical education classes dropped from 42
percent in 1991 to 32 percent in 2001. Health and fitness are linked to
improved academic achievement and grades, cognitive ability, and
behavior as well as reduced truancy.
Since fiscal year 2012, funding for CDC's school health activities
to prevent chronic diseases has essentially been level funded at $14.9
million. DPH provides a basic level of funding for school health
activities in all 50 States (about $75,000 per State). This small
amount of funding allows States to only conduct a minimum of school-
based health activities. The School Health Branch also provides an
enhanced level of funding on a competitive basis to a smaller number of
States. Increasing resources for the SHB will enable all 50 States and
DC to engage in enhanced school health activities that improve the
school nutrition environment and increase the quality and quantity of
physical education and physical activity opportunities. States would
also be strongly encouraged to fund a school health position at the
State education agency to coordinate efforts with the State health
department. CDC's Coordinated School Health Programs have been shown to
be cost-effective in improving children's health, their behavior, and
their academic success. This funding builds bridges between State
education and public health departments to coordinate health education,
nutritious meals, physical education, mental health counseling, health
services, healthy school environments, and parent and community
involvement.
Thank you for this opportunity to present our views to the
Subcommittee. We understand there will be tough choices to make in this
fiscal environment. However, public health funding only makes up 1.5
percent of Federal budget, and yields a much a greater return on
investment. We look forward to working with you to prevent chronic
illness, improve the quality of lives, and save billions of dollars in
healthcare spending.
[This statement was submitted by Elaine Auld, Chief Executive
Officer, Society for Public Health Education.]
______
Prepared Statement of the Society for Women's Health Research
The Society for Women's Health Research (SWHR) is pleased to have
the opportunity to submit the following testimony urging renewed
investment in scientific and medical research within the Department of
Health and Human Services (HHS). For almost 25 years, our organization
has been considered the thought leader in research on biological
differences in disease and is dedicated to transforming women's health
through science, advocacy, and education. We believe that a robust
Federal research agenda that is inclusive of women's health research is
critical for the U.S. to meet the needs and expectations of its
citizens. We request that for fiscal year 2015, Congress fund the
following agencies and programs at the following levels:
--Agency for Healthcare and Research Quality-$471 million
--Centers for Disease Control and Prevention-$6.904 billion
--Health Resources Services Administration-$6.113 billion
--National Institutes of Health-$32 billion
--Substance Abuse and Mental Health Services Administration-$3.6
billion
--Office of Research on Women's Health at NIH-$42 million
--HHS Office of Women's Health-$35 million
SWHR remains concerned with the ramifications of the Budget Control
Act and sequestration. Funding levels for Department of Health and
Human Services (HHS), were significantly cut and those agencies that
fall underneath the umbrella of HHS; The Agency for Healthcare Research
and Quality (AHRQ), Centers for Disease Control and Prevention (CDC),
Health Resources Services Administration (HRSA), National Institutes of
Health (NIH), Substance Abuse and Mental Health Services Administration
(SAMHSA), all play vital roles in improving and protecting the health
of Americans but are forced to do more with less funding. Continued
cuts to public health agencies decrease public health emergency
preparedness and response capabilities, reducing funding for States to
monitor air quality and offer mental health services, and increasing
the risk for infectious disease outbreaks. These are essential public
health services that save lives and protect our health. Currently,
healthcare spending is the largest driver of the Federal deficit. By
2021, estimates indicate that this spending will account for nearly
one-fifth of the U.S. economy. Proper and sustained Congressional
investment in medical and scientific research can ultimately save
valuable healthcare dollars that are wasted on inappropriate and
ineffective treatment. We realize that the current budgetary
environment limits the amount of monies available for a substantial
increase; however, the benefit from every dollar invested in medical
research outweighs the cost many times over and is, perhaps, the single
most cost effective strategy in reducing our Federal deficit. Past
investments in medical research have allowed scientists to begin
unraveling the biologic and genetic underpinning of disease. This
research has shown that biological sex impacts every organ of the body,
and plays an important role in disease susceptibility, prevalence, time
of onset and severity. Sex differences are evident in all major disease
categories, including cancer, obesity, and heart disease. These
differences are also evident in drug absorption, distribution,
metabolism and elimination. The medical community has now begun to
tailor treatments to meet the needs of individual patients, taking the
first step towards truly personalized medicine.
National Institutes of Health-NIH serves as the America's premier
medical research agency and is the largest source of funding for
biomedical and behavioral research in the world. Many of the medical
advances in recent decades are direct results from investments in the
agency. Unfortunately, years of flat-funding, without controlling for
rising inflation, has meant that NIH's overall budget has decreased by
10 percent between 2004 and 2014, and its purchasing power has
decreased by 22 percent. This number does not just impact NIH's campus
in Maryland. Approximately 85 percent of NIH funding is spent in
communities across the country, creating jobs at more than 3,000
universities, medical schools, teaching hospitals, and research
institutions. In 2013, NIH funded 750 fewer grants than in 2012 and
grant funding fell to an all-time low of 20 percent. A shrinking number
of available grants put scientists out of work. With limited
opportunities for research funding, scientists have little choice than
to pursue opportunities outside of academic research in the U.S.,
resulting in the loss of skilled bench scientists and researchers to
Asia, the European Union and the United Kingdom, who continue to
heavily invest in research. Unfortunately, the Administration's request
of a 0.7 percent increase doesn't make much headway in reversing the
$1.5 billion cut the agency sustained under sequestration in fiscal
year 2013, nor does it keep up with biomedical inflation rate,
projected by the HHS's Biomedical Research and Development Price Index,
to be 2.2 percent. Once that inflation rate is taken into account, the
Administration's budget request results in another cut to the Agency.
SWHR recommends that Congress set, at a minimum, a budget of $32
billion for NIH for fiscal year 2015. Further we recommend that
Congress expand NIH's mandate on the inclusion of women in basic
research to include women in all phases of basic, clinical and medical
research. Current practice only mandates sufficient female subjects
only in Phase III research, and researchers often miss out on the
chance to look for variability by sex in the early phases of research,
safety and effectiveness is determined.
Federal offices of women's health-The offices of women's health
within the Federal health agencies do critical work, both individually
and in collaboration with other offices and Federal agencies, to ensure
that women receive the appropriate care and treatments in a variety of
different areas. Under HHS, the agencies currently with offices,
advisors or coordinators for women's health or women's health research
include the AHRQ, CDC, FDA, HRSA, Indian Health Service (INS), and
SAMHSA. These offices do important work, both individually and in
collaboration with other offices and Federal agencies to ensure that
women receive the appropriate care and treatments in a variety of
different areas. In a time of limited budgetary dollars, Congress
should invest in these offices that promote working in collaboration
with other agencies, which shares much needed expertise while avoiding
unnecessary duplication. SWHR recommends that these offices be
sufficiently funded to ensure that these programs can continue to
provide much needed services to women and their families in fiscal year
2015.
Office of Research on Women's Health--ORWH is the focal point for
coordinating women's health and sex differences research at NIH, and
supports innovative interdisciplinary initiatives that focus on women's
health and sex differences research. ORWH promotes opportunities for
and support of recruitment, retention, re-entry and advancement of
women in biomedical careers. The Building Interdisciplinary Research
Careers in Women's Health (BIRCWH) is an innovative, trans-NIH career
development program that pairs junior faculty with senior investigators
in a mentored environment. Approximately 500 scholars, the majority of
them female, have been trained at 39 centers and have produced
approximately 5,000 publications. ORWH's administrative supplements for
research on sex and fender differences, a trans-NIH initiative to
broaden the field of sex and gender differences research, adds new
dimensions to on-going studies. The specialized centers of research on
sex and gender factors affecting women's health (SCOR) are designed to
integrate basic and clinical approaches to sex and gender research
across scientific disciplines and has resulted in over 650 articles,
reviews, abstracts, book chapters and other publications. To allow
ORWH's programs and research grants to continue make their impact on
the research community, Congress must direct that NIH continue its
support of ORWH and provide it with a $1 million dollar budget
increase, bringing its fiscal year 2015 total to $42 million.
Health and Human Services' Office of Women's Health-The HHS OWH is
the government's champion and focal point for women's health issues. It
works to address inequities in research, healthcare services, and
public education gaps, which have historically placed the health of
women at risk. Without OWH's actions, the task of translating research
into practice would be only more difficult and delayed. Considering the
impact of women's health programs from OWH on the public, we urge
Congress to provide an increase of $1 million for this office, a total
of $35.7 million for fiscal year 2015.
In conclusion, Mr. Chairman, we thank you and this Committee for
its support for medical and health services research and its commitment
to the health of the Nation. We look forward to continuing to work with
you to build a healthier future for all Americans.
[This statement was submitted by Leslie Ritter, Director of
Government Affairs, Society for Women's Health Research.]
______
Prepared Statement of the Squaxin Island Tribe
On behalf of the Tribal Leadership and members of the Squaxin
Island Tribe, I am honored to submit our recommendation to this
Subcommittee for appropriations to address the un-funded needs of
American Indian and Alaska Native Treatment (AI/AN) Centers. The
alarming statistics of increased alcohol and substance abuse use in the
AI/AN communities speaks volumes to the need for improved and
additional facilities to provide treatment and recovery opportunities
to our citizens, our youths, our future leaders and the next seven
generations. Although SAMHSA has limited discretionary funding and even
less resources for residential care facilities, the Indian Health
Service cannot keep pace with the growing need for these treatment
centers. The only funding opportunity available in SAMHSA is the
Treatment for Pregnant and Postpartum Women. In 2015, we respectfully
request the Subcommittee:
--$10 million--Expand access to residential care facility
appropriations to include Treatment Centers and increase the
annual appropriations to supplement inadequate funding for
these centers from the Indian Health Service of which the NWITC
will receive $1.5 million;
--$50 million--SAMHSA's Behavioral Health Tribal Prevention Grant
Program; and,
--$15 million--SAMHSA for Behavioral Health
The Squaxin Island Tribe has been operating the Northwest Indian
Treatment Center (NWITC) since 1994. Ingenious in creativity, the
center offers a wide variety of cultural activities and traditional/
religious ceremonies, making it a natural place to heal--body, mind and
soul. Fittingly, the center was given the spiritual name ``D3WXbi
Palil'' meaning ``Returning from the Dark, Deep Waters to the Light.''
NWITC is a residential chemical dependency treatment facility designed
to serve American Indians from Tribes located in Oregon, Washington and
Idaho who have chronic relapse patterns related to unresolved grief and
trauma. NWITC is unique in its integration of Tribal cultural values
into a therapeutic environment for co-occurring substance abuse and
mental health disorders. It is a 28 bed, 30-60 day residential
facility.
Welcomed and hailed by Tribal Leaders who felt the urgent need for
such a facility, NWITC is centrally located in Grays Harbor County
between Olympia and Aberdeen, on 2.5 acres in the small rural town of
Elma, Washington. NWITC accepts patients that are referred through
outpatient treatment programs, parole and probation services,
hospitals, assessment centers and child and family service centers.
Medical care is provided through local Indian Health Service clinics
and other medical service providers. NWITC has responded with an
overwhelming success rate of nearly 65 percent.
Since the original Congressional set-aside in 1993, NWITC has not
received an adequate increase in the base Indian Health Service budget.
It is critical to increase the NWITC's annual base in order to sustain
the current services to the Tribes of the Northwest. An increase of
$1.5 million would restore lost purchasing power and meet the need to
add mental health and psychiatric components to the treatment program.
This increase would allow NWITC to continue its effective treatment of
Native Americans.
In 2011, the NWITC served 225 patients from 28 Tribes and added
intensive case management and crisis support to alumni in order to
continue to promote positive outcomes for clients. Despite funding
challenges, NWITC has continued to develop and deliver innovative,
culturally appropriate services to meet increasingly complex demands.
The Treatment Center's traditional foods and medicines program is
supported through a partnership with the Northwest Indian College and
is funded through grants from the Washington Health Foundation, the
National Institute of Food and Agriculture, The Potlatch Fund and
several Tribes. Weekly hands-on classes focus on traditional foods and
medicines, including methods for growing, harvesting, processing, and
preparation. Twice a month, Tribal elders, storytellers, and cultural
specialists speak as part of the program. A monthly family class allows
patients to share what they are learning with their loved ones.
Patients gain hands-on experience by working in three on-site teaching
gardens. This program serves as a model for other Tribal communities.
$50 million--SAMHSA Behavioral Health Tribal Prevention Grant Program
The Behavioral Health Tribal Prevention Grant will support
behavioral health services that promote overall mental and emotional
health, specifically substance abuse prevention and suicide prevention
services. If funded, the grant program would be the only source for
Federal substance abuse and suicide prevention funding exclusively
available to Tribes.
$15 million--SAMHSA for Behavioral Health
This SAMHSA grant program has been authorized to award grants to
Indian health programs to provide prevention or treatment of drug use
or alcohol abuse, promotion of mental health, or treatment services for
mental illness. To date, these funds have never been appropriated. An
appropriation of $15 million would provide support to Indian health
programs to meet the critical substance abuse and mental health needs
of our citizens.
Self-Governance--An Efficient and Effective Use of Federal Funds (Title
VI of the ISDEAA)
Self-Governance is the most successful policy in the history of
Tribal--Federal relations and it inspires efficient and effective
government spending. Through Self-Governance, Tribes are empowered, as
sovereign nations, to exercise self-determination and to design
facilities, manage programs and funds, and provide services that are
responsive to the needs of our communities and Tribal citizens. Tribes
participating in Self-Governance have become successful in the business
of healthcare and perform several key roles, serving as, governments,
employers, healthcare providers and patients.
Self-Governance Tribes have made every attempt to be innovative to
operate successful health programs given the budget constraints and
cuts Tribal programs have incurred the past two decades. For more than
a decade we have made every effort to expand Self-Governance to other
programs and our efforts to seek expansion of the program will continue
until we achieve our goal. We request that this Committee recognizes
the success of Self-Governance and encourage HHS to work with Tribes to
make the most efficient and effective use of Federal appropriations to
fund Tribal programs.
Thank you for this opportunity to submit written testimony.
[This statement was submitted by Dave Lopeman, Chairman, Squaxin
Island Tribe.]
______
Prepared Statement of the Treatment Advocacy Center
The Treatment Advocacy Center is grateful for the opportunity to
submit this testimony in support of the Department of Health and Human
Services' Assisted Outpatient Treatment (AOT) Grant Program (AOT Grant
Program) for Individuals with Serious Mental Illness. The Treatment
Advocacy Center supports full funding of the AOT Grant Program at
$15,000,000 for each of the fiscal years 2015 through 2018.
The Treatment Advocacy Center (Organization) is a national
nonprofit organization dedicated to eliminating barriers to the timely
and effective treatment of severe mental illness. The Organization
promotes laws, policies and practices for the delivery of psychiatric
care and supports the development of innovative treatments for and
research into the causes of severe and persistent psychiatric
illnesses, such as schizophrenia and bipolar disorder. The Treatment
Advocacy Center is funded by a host of individual donors, foundations
and grants and does not accept funding from companies or entities
involved in the sale, marketing, or distribution of pharmaceutical
products.
In far too many communities across the country, individuals whose
severe mental illness impairs their ability to seek and voluntarily
comply with treatment become caught up in a revolving door of
hospitalization, incarceration, homelessness and repeated
victimization. This small segment of the total population of
individuals with a severe mental illness consumes a disproportionate
percentage of their communities' limited mental health resources,
without a concurrent benefit. AOT is a lifeline that can break this
cycle, allowing this otherwise highly vulnerable population to survive
and thrive safely in the community. AOT achieves this by providing
medically prescribed mental health treatment under court order.
Unfortunately, local communities are sometimes unable to realize
AOT's benefits due to the initial start-up costs of moving away from
their current flawed approach to one that effectively utilizes AOT. The
AOT Grant Program will help to address this concern by providing
communities with resources they can leverage to implement these proven
programs. Studies show that AOT benefits not only those who receive
court-ordered treatment, but also, ``those who will be served in a more
efficient public behavioral healthcare system . . . with greater
capacity that produces better outcomes for a broader population in
need.'' \1\ For example, an analysis of New York's Kendra's Law found
that, ``In the long run . . . overall service capacity was increased,
and the focus on enhanced services for AOT participants appears to have
led to greater access to enhanced services for both voluntary and
involuntary recipients'' \2\
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\1\ Swanson, Jeffrey W., Van Dorn, Richard A., Swartz, Marvin S.,
Robbins, Pamela Clark, Steadman, Henry J., McGuire, Thomas G., and John
Monahan. 2013. ``The Cost of Assisted Outpatient Treatment: Can It Save
States Money?'' American Journal of Psychiatry 170:1423-1432.
\2\ Swanson, Jeffrey W., Van Dorn, Richard A., Swartz, Marvin S.,
Cislo, Andrew M., Wilder, Christine M., Moser, Lorna L., Gilbert,
Allison R., and Thomas McGuire. 2010. ``Robbing Peter to Pay Paul: Did
New York State's Outpatient Commitment Program.
Crowd Out Voluntary Service Recipients?'' Psychiatric Services 61:
1-10.
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AOT is a Proven Means of Assisting Those Most in Need
AOT is proven to help address the revolving door that traps far too
many individuals with severe mental illness. In 2012, the Department of
Justice deemed AOT to be an effective, evidence-based program for
reducing crime and violence.\3\
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\3\ Assisted Outpatient Treatment. Department of Justice Office of
Justice Programs. Retrieved from http://www.crimesolutions.gov/
ProgramDetails.aspx?ID=228.
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AOT Reduces Hospitalization
Researchers in 2009 conducted an independent evaluation of New
York's court-ordered outpatient treatment law (Kendra's Law) and
documented a striking decline in the rate of hospitalization among
participants. During a 6-month study period, AOT recipients were
hospitalized at less than half the rate they were hospitalized in the 6
months prior to receiving AOT. Among those admitted, hospital stays
were shorter: average length of hospitalization dropped from 18 days
prior to AOT to 11 days during the first 6 months of AOT and 10 days
for the seventh through twelfth months of AOT.\4\
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\4\ Swartz, Marvin S., Swanson, Jeffrey W., Steadman, Henry J.,
Robbins, Pamela Clark, and John Monahan. 2009. New York State Assisted
Outpatient Treatment Program Evaluation. Duke University School of
Medicine.
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A randomized controlled study in North Carolina (Duke Study) in
1999 demonstrated that intensive routine outpatient services alone,
without a court order, did not reduce hospital admission. However, when
the same level of services (at least three outpatient visits per month,
with a median of 7.5 visits per month) were combined with long-term AOT
(6 months or more), hospital admissions were reduced 57 percent, and
length of hospital stay was reduced by 20 days compared to individuals
receiving the services alone. The results were even more dramatic for
the subset of individuals with schizophrenia and other psychotic
disorders--long-term AOT reduced hospital admissions by 72 percent and
length of hospital stay by 28 days compared with services alone. The
participants in the North Carolina study were from both urban and rural
communities and ``generally did not view themselves as mentally ill or
in need of treatment.'' \5\
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\5\ Swartz, Marvin S., Swanson, Jeffrey W., Wagner, H. Ryan, Burns,
Barbara J., Hiday, Virginia A., and Randy Borum. ``Can Involuntary
Outpatient Commitment Reduce Hospital Recidivism?: Findings from a
Randomized Trial With Severely Mentally Ill Individuals.'' American
Journal of Psychiatry 156: 1968-1975.
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A Washington State study of 115 patients found that AOT decreased
hospitalization by 30 percent over 2 years. The savings in hospital
costs for these 115 patients alone was $1.3 million.\6\ In an AOT
program in Florida, AOT reduced hospital days from 64 to 37 days per
patient over 18 months, a 43 percent decrease. The savings in hospital
costs averaged $14,463 per patient.\7\
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\6\ Zanni, Guido and Paul F. Stavis. 2007. ``The Effectiveness and
Ethical Justification of Psychiatric Outpatient Commitment.'' American
Journal of Bioethics 7: 31-41.
\7\ Esposito, Rosanna, Westhead, Valerie, and Jim Berko. 2008.
``Florida's Outpatient Commitment Law: Effective but Underused''
(letter). Psychiatric Services 59: 328.
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AOT Reduces Arrests and Incarceration
A study of Kendra's Law published in 2010 concluded that the ``odds
of arrest in any given month for participants who were currently
receiving AOT were nearly two-thirds lower'' than those not receiving
AOT.\8\ According to a 2005 New York State Office of Mental Health
report on Kendra's Law, arrests for AOT participants were reduced by 83
percent, from 30 percent prior to the onset of a court order to only 5
percent after participating in the program.\9\
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\8\ Gilbert, Allison R., Moser, Lorna L., Van Dorn, Richard A.,
Swanson, Jeffrey W., Wilder, Christine M., Robbins, Pamela Clark,
Keator, Karli J., Steadman, Henry J., and Marvin S. Swartz. 2010.
``Reductions in Arrest Under Assisted Outpatient Treatment in New
York.'' Psychiatric Services 61: 996-999.
\9\ New York State Office of Mental Health. 2005. Kendra's Law:
Final Report on the Status of Assisted Outpatient Treatment.
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A Florida report found AOT reduced days spent in jail among
participants from 16.1 to 4.5 days, a 72 percent reduction.\10\
Similarly, the Duke Study found that, for individuals who had a history
of multiple hospital admissions combined with arrests and/or violence
in the prior year, long-term AOT reduced the risk of arrest by 74
percent. The arrest rate for participants in long-term AOT was 12
percent, compared with 47 percent for those who had services without a
court order.\11\
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\10\ Esposito, Rosanna, Westhead, Valerie, and Jim Berko. 2008.
``Florida's Outpatient Commitment Law: Effective but Underused''
(letter). Psychiatric Services 59: 328.
\11\ Swanson, Jeffrey W., Borum, Randy, Swartz, Marvin S., Hiday,
Virginia A., Wagner, H. Ryan, and Barbara J. Burns. 2001a. ``Can
Involuntary Outpatient Commitment Reduce Arrests Among Persons with
Severe Mental Illness?'' Criminal Justice and Behavior 28: 156-189.
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AOT Reduces Violence, Crime, and Victimization.
The New York State Office of Mental Health report also found that
Kendra's Law resulted in dramatic reductions in harmful behaviors for
AOT. Among AOT recipients at 6 months of assisted outpatient treatment
compared to a similar period of time prior to the court order: 55
percent fewer recipients engaged in suicide attempts or physical harm
to self; 47 percent fewer physically harmed others; 46 percent fewer
damaged or destroyed property; and 43 percent fewer threatened physical
harm to others. Overall, the average decrease in harmful behaviors was
44 percent.\12\
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\12\ New York State Office of Mental Health. 2005. Kendra's Law:
Final Report on the Status of Assisted Outpatient Treatment.
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A 2010 study by Columbia University's Mailman School of Public
Health reached equally striking findings about the impact of Kendra's
Law on the incidence of violent criminal behavior. When AOT recipients
in New York City and a control group of other mentally ill outpatients
were tracked and compared, the AOT patients--despite having more
violent histories--were found four times less likely to perpetrate
serious violence after undergoing treatment.\13\
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\13\ Phelan, Jo C., Sinkewicz, Marilyn, Castille, Dorothy, Huz,
Steven, and Bruce G. Link. 2010. ``Effectiveness and Outcome of
Assisted Outpatient Treatment in New York State.'' Psychiatric Services
61: 137-143.
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The Duke Study found that long-term AOT combined with intensive
routine outpatient services was significantly more effective in
reducing violence and improving outcomes for severely mentally ill
individuals than the same level of outpatient care without a court
order. Among a group of individuals characterized as ``seriously
violent,'' 63.3 percent of those not in long-term AOT repeated violent
acts, while only 37.5 percent of those in long-term AOT did so. Long-
term AOT combined with routine outpatient services reduced the
predicted probability of violence by 50 percent.\14\
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\14\ Swanson, Jeffrey W., Swartz, Marvin S., Borum, Randy, Hiday,
Virginia A., Wagner, H. Ryan, and Barbara J. Burns. 2001. ``Involuntary
Outpatient Commitment and Reduction of Violent Behaviour in Persons
with Severe Mental Illness.'' British Journal of Psychiatry 176: 224-
231.
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The Duke Study further demonstrated that individuals with severe
psychiatric illnesses who were not on AOT ``were almost twice as likely
to be victimized as were outpatient commitment subjects.'' 24 percent
of those on AOT were victimized, compared with 42 percent of those not
on AOT.\15\
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\15\ Hiday, Virginia A., Swartz, Marvin S., Swanson, Jeffrey W.,
Borum, Randy, and H. Ryan Wagner. 2002. ``Impact of Outpatient
Commitment on Victimization of People with Severe Mental Illness.''
American Journal of Psychiatry 159: 1403-1411.
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AOT Improves Treatment Compliance
AOT has also been shown to be effective in increasing treatment
compliance. In New York, AOT led to a 51 percent increase in
recipients' exhibition of good service engagement, and more than
doubled the exhibition of ``good'' adherence to medication.\16\
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\16\ New York State Office of Mental Health. 2005. Kendra's Law:
Final Report on the Status of Assisted Outpatient Treatment.
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In North Carolina, only 30 percent of AOT patients refused
medication during a 6-month period, compared to 66 percent of patients
not under AOT.\17\ In Ohio, AOT increased attendance to outpatient
psychiatric appointments from 5.7 to 13.0 per year; it also increased
attendance at day treatment sessions from 23 to 60 per year.\18\
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\17\ Hiday, Virginia A. and Teresa L. Scheid-Cook. 1987. ``The
North Carolina Experience with Outpatient Commitment: A Critical
Appraisal.'' International Journal of Law and Psychiatry 10: 215-232.
\18\ Munetz, Mark R., Grande, Thomas, Kleist, Jeffrey, and Gregory
A. Peterson. 1996. ``The Effectiveness of Outpatient Civil
Commitment.'' Psychiatric Services 47: 1251-1253.
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AOT also promotes long-term voluntary treatment compliance. In
Arizona, ``71 percent [of AOT patients] . . . voluntarily maintained
treatment contacts 6 months after their orders expired'' compared with
``almost no patients'' who were not court-ordered to outpatient
treatment.\19\ In Iowa, ``it appears as though outpatient commitment
promotes treatment compliance in about 80 percent of patients while
they are on outpatient commitment. After commitment is terminated,
about three-quarters of that group remained in treatment on a voluntary
basis.'' \20\
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\19\ Van Putten, Robert A., Santiago, Jose M., and Michael R.
Berren. 1988. ``Involuntary Outpatient Commitment in Arizona: A
Retrospective Study.'' Hospital and Community Psychiatry 39: 953-958.
\20\ Rohland, Barbara M. 1998. The Role of Outpatient Commitment in
the Management of Persons with Schizophrenia. Iowa City: Iowa
Consortium for Mental Health, Services, Training, and Research.
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The New York Independent Evaluation also yielded interesting
findings on the likelihood of voluntary compliance after AOT is allowed
to expire. For individuals who received AOT for periods of 6 months or
less, the researchers found that post-AOT sustainability of
improvements in medication adherence depended on whether intensive
outpatient services were continued on a voluntary basis. Those who
continued with intensive services maintained their substantial increase
in medication adherence relative to the pre-AOT period (from 37 to 45
percent); those who discontinued such assistance dropped back to near
the pre-AOT levels (33 percent). Patients who received AOT for more
than 6 months, however, experienced increased medication adherence
whether or not intensive services were continued. The medication
adherence rate was higher for those who continued intensive services
than for those who did not (50 percent vs. 43 percent), but both groups
maintained substantial improvements from the pre-AOT rate (37
percent).\21\
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\21\ Swartz, Marvin S., Swanson, Jeffrey W., Steadman, Henry J.,
Robbins, Pamela Clark, and John Monahan. 2009. New York State Assisted
Outpatient Treatment Program Evaluation. Duke University School of
Medicine.
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The Treatment Advocacy Center reemphasizes it support for full
funding of the AOT Grant Program at $15,000,000 for each of the fiscal
years 2015 through 2018. Should you have any questions, please feel
free to contact John Snook, Deputy Executive Director, Treatment
Advocacy Center at (703) 294-6006 or
snookj@treatmentadvocacycenter.org.
______
Prepared Statement of the Trevor Project
Dear Chairman Harkin and Senator Moran: The Trevor Project
appreciates the opportunity to submit a statement on the critical and
timely issue of funding for children's suicide prevention and mental
health initiatives. We encourage you to support our Nation's most
vulnerable youth by funding these vital programs:
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
President's Fiscal year 2015
Program Fiscal year 2014 proposed fiscal trevor project
enacted year 2015 budget recommendation
----------------------------------------------------------------------------------------------------------------
SAMHSA--Suicide Prevention Programs.............. 51 40.1 61
HHS/ACF--Runaway and Homeless Youth Act Funding.. 114.1 114 152.5
NIMH--Suicide Prevention Research................ ................... ................... 40
CDC--National Violent Death Reporting System..... 11.3 23.5 25
SAMHSA Project AWARE............................. 55 55 60
----------------------------------------------------------------------------------------------------------------
The Trevor Project is the leading national organization providing
crisis intervention and suicide prevention services to lesbian, gay,
bisexual, transgender and questioning (LGBTQ) young people under 24.
Among young people ages 10 to 24, suicide is the second leading cause
of death.\1\ According to the National Survey of Children's Health, up
to 20 percent of young people have a diagnosable mental illness, but
only 60 percent of those in need of mental healthcare receive the
treatment they require.\2\ In fact, half of all individuals with mental
illness experience onset of the disorder by age 14, but do not seek
treatment, on average, until the age of 24.\3\ For youth, the
consequences of untreated mental illness vary and include increased
suicide risk, school failure, involvement in the criminal justice
system, unemployment, substance abuse, and homelessness. Among
stigmatized populations such as LGBTQ young people, these negative
outcomes can be exacerbated by prejudice, fear, and hate experienced in
homes, schools, and communities.
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\1\ Centers for Disease Control and Prevention, National Center for
Injury Prevention and Control, Web-based Injury Statistics Query and
Reporting System (WISQARS), available at http://www.cdc.gov/ncipc/
wisqars (last visited Mar. 14, 2013).
\2\ 2007 National Survey of Children's Health, Data Resource Center
for Child & Adolescent Health, Child and Adolescent Health Measurement
Initiative, http://www.nschdata.org (last visited May 2009).
\3\ Ronald C. Kessler et al., Lifetime Prevalence and Age-of-Onset
Distributions of DSM-IV Disorders in the National Co-morbidity Survey
Replication (NCSR), 62 GENERAL PSYCHIATRY 593 (2005); and Philip S.
Wang et al., Failure and Delay in Initial Treatment Contact After First
Onset of Mental Disorders in the National Co-morbidity Survey
Replication (NCS-R), 62 GENERAL PSYCHIATRY 603 (2005).
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Suicidality is closely associated with mental illness; more than 90
percent of those who die by suicide have a diagnosable mental
disorder.\4\ Therefore suicide prevention is an essential component of
a comprehensive mental health system.
---------------------------------------------------------------------------
\4\ Suicide in the U.S.: Statistics and Prevention, National
Institute of Mental Health, available at http://www.nimh.nih.gov/
health/publications/suicide-in-the-us-statistics-and-prevention/index.
shtml#Moscicki-Epi (last visited Mar. 14, 2013).
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We thank the Committee for your ongoing support for suicide
prevention and mental health initiatives, and we hope that this letter
will identify the critical programs that exist to protect our most
vulnerable youth.
The Trevor Project recommends the following fiscal year 2015
appropriations to improve access to effective mental healthcare and
reduce suicide risk for young people:
garrett lee smith memorial act suicide prevention programs (samhsa)
The Garrett Lee Smith Memorial Act provides the largest dedicated
source of Federal funding for youth suicide prevention efforts, which
are a life-saving and effective means to address the daunting issue of
youth suicide. We can help avoid tragedy by appropriately funding
programs that focus on extreme harming behaviors and mental illness in
young people. To date, Garrett Lee Smith funding has supported suicide
prevention programs in 49 States, 48 tribes, and 138 colleges. Fully
appropriating these programs would ensure that the Suicide Prevention
Resource Center continues to provide technical assistance to
organizations nationwide; and it would allow for the expansion of
State, tribal, and campus grants. Also encompassed within our funding
recommendations for these programs is the National Strategy for Suicide
Prevention, which works towards a unified approach to suicide
prevention through collaboration between public and private sectors;
and the National Suicide Prevention Lifeline, which answers more than
94,000 calls a month, including calls from veterans, active duty
members and their families, as well as the general public.
runaway and homeless youth act (health and human services)
An estimated 40 percent of all homeless youth are LGBTQ-identified,
often because they are thrown out of their homes or face family
rejection.\5\ Nearly 2/3 of these young people are likely to attempt
suicide at least once.\6\
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\5\ Durso, L. E. & Gates, G. J. (2012). Serving our youth: Findings
from a national survey of service providers working with lesbian, gay,
bisexual, and transgender youth who are homeless or at risk of becoming
homeless. Los Angeles, CA: The Williams Institute with True Colors Fund
and The Palette Fund.
\6\ Van Leeuwen, J. M., Boyle, S., Salomonsen-Sautel, S., Baker, D.
N., Garcia, J. T., Hoffman, A. & Hopfer, C. J. (2006). Lesbian, gay,
bisexual homeless youth: An eight-city public health perspective. Child
Welfare 85(2), 151-170.
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HUDs last Point in Time Count counted over 46,000 homeless youth,
but less than 5,000 beds. Less than 10 percent of our homeless youth
are receiving services, but funding for the RHYA has not significantly
increased since 2008, despite a growing population desperately in need
of the services provided by this Act. In order to meet the
Administration's goal of ending youth homelessness by 2020, funding for
runaway and homeless youth services needs to significantly increase.
Through the RHYA, Congress ensures funding for community outreach
programs, transitional housing and support services, and counseling and
reunification guidance for families to be reconnected. Congress should
appropriate $152.5 million to help keep our vulnerable youth safe and
healthy as part of a nationwide commitment to ending youth homelessness
by 2020.
suicide prevention research (nimh)
There is a strong correlation between research funding and
morbidity rates associated with diseases and disorders. Between 2009
and 2012, $165 million has been spent on suicide prevention research,
and yet in the last decade, suicide rates have increased by 31 percent.
Conversely, over 5 billion dollars has been spent on heart disease
research, and rates in the past decade have decreased by 16 percent.
We encourage you to include an additional $40 million for the
National Institute of Mental Health to conduct suicide prevention and
brain research, a recommendation that reflects current legislation in
the Senate and House (S. 2305/H.R. 7045), the Suicide Prevention
Research INnovaTion Act (the SPRINT Act). The SPRINT Act aims to reduce
the risk of self-harm, suicide, and interpersonal violence, especially
in rural communities with a shortage of mental health services.
project aware--(samhsa)
The President's Now is the Time plan is an important step forward
to effectively address school safety and youth mental health. These
programs must be adequately funded in order to fulfill the promise of
making our schools and communities safe for all young people. Through
piloting Mental Health First Aid training with $20 million , Project
AWARE would support innovative, State-based strategies for improving
mental health training and responsiveness to mental health emergencies;
and would be particularly effective in rural communities, where
community mental health services are less frequently available.
Additionally, through $40 million in State grants, Project AWARE would
put more trained teachers and mental health professionals on the
ground; help school districts make sure students get the referrals they
needs; and would underscore the importance of prevention by offering
students mental health services for trauma or anxiety, conflict
resolution programs, and other school-based violence prevention
strategies.
national violent death reporting system (nvrds) (cdc)
The NVDRS serves as a clearinghouse for the details and
circumstances surrounding suicides completed in the jurisdictions in
which it operates. This valuable information informs suicide prevention
and crisis intervention efforts, but it is currently only collected in
18 States. Proposals to expand this system have received broad
bipartisan support, and the NVDRS expansion was included in the Mental
Health Awareness and Improvement Act (S. 689), which passed nearly
unanimously in the Senate as an amendment to S. 649. Fully funding the
NVRDS with $25 million would allow nationwide collection of this data
to further public health research on suicide prevention.
Conclusion
We thank the Committee for taking the time to fully assess our
Nation's mental healthcare system, and we appreciate the opportunity to
provide a written statement. We strongly support efforts to increase
access to suicide prevention and mental healthcare for young people,
and we urge the Committee to fully fund these critical programs.
[This statement was submitted by Abbe Land, Executive Director &
CEO, Trevor Project.]
______
Prepared Statement of the Tri-Council for Nursing
The Tri-Council for Nursing, comprising the American Association of
Colleges of Nursing (AACN), the American Nurses Association, the
American Organization of Nurse Executives, and the National League for
Nursing, respectfully requests $251 million for the Nursing Workforce
Development programs authorized under Title VIII of the Public Health
Service Act (42 U.S.C. 296 et seq.) and administered by the Health
Resources and Services Administration in fiscal year 2015.
The Tri-Council is a long-standing nursing alliance focused on
leadership and excellence in the nursing profession. The members of
these respective organizations are acutely aware of the demand for
nursing services due to a growing aging population, an increased focus
on preventative care, and skyrocketing rates of individuals with
multiple chronic conditions. In fact, according to the U.S. Bureau of
Labor Statistics (BLS) Employment Projections for 2012-2022, the
profession of registered nurses (RN) will grow by 19 percent for the
10-year timeframe between 2012 and 2022. The number of job openings due
to both the increasing demand for nursing services and the large number
of retiring RNs, brings the total of RNs needed to 1.053 million by
2022. A 2013 HRSA report, The U.S. Nursing Workforce: Trends in Supply
and Education, indicates that over the next 10 to 15 years, the nearly
one million RNs over age 50 (comprising approximately one-third of the
current workforce), will reach retirement age.
Moreover, the acute nurse faculty shortage is one significant
reason why schools of nursing across the country turn away tens of
thousands of qualified applications each year. The demand for nurses
and the faculty who educate them is a serious impediment to improving
the Nation's healthcare needs. Nurses continue to be the largest group
of healthcare providers whose services are directly linked to quality
and cost-effectiveness. The Tri-Council is grateful to the Subcommittee
for your past commitment to Title VIII funding and respectfully asks
that you continue to make the long-term investment that will build the
nursing workforce necessary to deliver the quality, affordable care
envisioned in health reform.
A Proven Solution: Nursing Workforce Development Programs
The Nursing Workforce Development programs, authorized under Title
VIII of the Public Health Service Act, have helped build the supply and
distribution of qualified nurses to meet our Nation's healthcare needs
since 1964. Over these past 50 years, the original programs, newly
added, and expanded programs have addressed all aspects of supporting
the workforce--education, practice, retention, and recruitment. They
have bolstered nursing education at all levels--from entry-level
preparation through graduate study--and have provided support for
institutions that educate nurses who practice in rural and medically
underserved communities. A description of the Title VIII programs and
their impact are included below.
Advanced Nursing Education (ANE) Programs (Sec. 811) fund a number
of grant activities--including several traineeships--that aim to
increase the size and quality of the advanced nursing workforce.
Supporting the preparation of RNs in master's and doctoral nursing
programs, the ANE grants help prepare our Nation's nurse practitioners,
clinical nurse specialists, nurse midwives, nurse anesthetists, nurse
educators, nurse administrators, nurses in executive practice, public
health nurses, and other nursing specialists requiring advanced nursing
education. In fiscal year 2012, these grants supported the education of
15,986 students. Under the ANE program are two critical traineeship
programs that are particularly relevant as the demand for primary and
acute care services rise.
Advanced Education Nursing (AEN) Traineeships assist graduate
nursing students by providing full or partial reimbursement for the
costs of tuition, books, program fees, and reasonable living expenses.
Funding for the AEN Traineeships supports the education of future nurse
practitioners, clinical nurse specialists, nurse midwives, nurse
anesthetists, nurse educators, nurse administrators, public health
nurses, and other nurse specialists requiring advanced education.
Nurse Anesthetist Traineeships (NAT) support the education of
students in nurse anesthetist programs. In some States, certified
registered nurse anesthetists are the sole anesthesia providers in
almost 100 percent of rural hospitals.
In fiscal year 2012, the AEN Traineeship and the NAT supported
5,545 nursing students.
Nursing Workforce Diversity (NWD) Grants (Sec. 821) prepare
students from disadvantaged backgrounds to become nurses, producing a
more diverse nursing workforce. This outcome will help meet the
increasing need for culturally aligned, quality healthcare for the
Nation's rapidly diversifying population and help close the gap in
health disparities. This program awards grants and contract
opportunities to schools of nursing for a variety of clinical training
facilities to address nursing educational needs, not only for
disadvantaged students, but also or racial and ethnic minorities
underrepresented in the nursing profession. In fiscal year 2012, the
program supported 12,077 students.
Nurse Education, Practice, Quality and Retention (NEPQR) Grants
(Sec. 831) help schools of nursing, academic health centers, nurse-
managed health clinics, as well as State and local governments
strengthen nursing education programs, thereby increasing the size and
quality of the nursing workforce. The purposes of the NEPQR grants are
broad and flexible, allowing the program to address emerging needs in
nursing workforce development. For example, projects have been funded
to develop and disseminate collaborative practice models that
incorporate the full range of healthcare workers in team-based care are
of certain interest. NEPQR supports infrastructure development to
enhance the coordination and capacity building of interprofessional
practice and education among health professions across the United
States, and particularly in medically underserved areas.
For other interests, a number of grant activities have been funded
to support several legislative purposes such as expanding the size of
academic programs that are able to confer a baccalaureate degree of
science in nursing (BSN); recruiting and educating individuals as
qualified personal and home care aides in occupational shortage and/or
high demand areas; training qualified nursing assistants and home
health aides to meet the growing healthcare needs of the aging
population; and/or supporting nurse-managed health clinics that serve
as primary care access points in areas where primary care providers are
in short supply.
NURSE Corps (formerly known as the Nursing Education Loan Repayment
and Scholarship Program) (Sec. 846) provides monies to students by
paying up to 85 percent of a student's loan in return for at least 3
years of service in a designated health shortage area or in an
accredited school of nursing. The NURSE Corps Loan Repayment Program
(LRP) is a financial incentive program under which individual RNs and
advanced practice registered nurses enter into a contractual agreement
with the Federal Government to work full-time in a healthcare facility
with a critical shortage of nurses, in return for repayment of
qualifying nursing educational loans. In fiscal year 2013, the Nursing
Education Loan Repayment Program supported 1,446 nurses working in
these facilities. However, given the current climate, the HRSA 2015
Congressional Budget Justification anticipates that they will only be
able to support 1,296 in fiscal year 2014.
Nurse Faculty Loan Program (NFLP) (Sec. 846 A) increases the number
of qualified nurse faculty by creating a student loan fund within
individual schools of nursing. Students agree to teach at a school of
nursing in exchange for cancellation of up to 85 percent of their
educational loans, plus interest, over a 4-year period. In fiscal year
2012, these grants supported the education of 2,259 future nurse
educators.
Comprehensive Geriatric Education Program (CGEP) Grants (Sec. 855)
provide support to nursing students specializing in care for the
elderly. These grants may be used to educate RNs who will provide
direct care to older Americans, develop and disseminate geriatric
curriculum, prepare faculty members, and provide continuing education.
They may also fund traineeships for individuals who are preparing for
advanced education nursing degrees in geriatric nursing, long-term
care, gero-psychiatric nursing or other nursing areas that specialize
in the care of the elderly population. In fiscal year 2012, there were
11,600 trainees supported by these grants.
Our Nation is faced with a growing healthcare crisis that must be
addressed on many fronts. Nurses are an important part of the solution
to the crisis of cost, burden of disease, and access to quality care.
To meet this challenge, funding of proven Federal programs such as
Title VIII will help ease the demand for RNs. The Tri-Council
respectfully requests your support for $251 million for the Title VIII
Nursing Workforce Development Programs in fiscal year 2015. If our
organizations can be of assistance, please contact AACN's Director of
Government Affairs and Health Policy, Dr. Suzanne Miyamoto, at
Smiyamoto@aacn.nche.edu.
Sincerly,
Eileen Breslin, PhD, RN, FAAN, President, Geraldine
``Polly'' Bednash, PhD, RN, FAAN, Chief Executive Officer,
American Association of Colleges of Nursing; Linda Knodel,
MHA, MSN, RN, NE-BC CPHQ, FACHE, President, Pamela A.
Thompson, MS, RN, CENP, FAAN , Chief Executive Officer and
Sr. Vice President, American Organization of Nurse
Executives; Karen Daley, PhD, MPH, RN, FAAN,President,Marla
J. Weston, PhD, RN, FAAN, Chief Executive Officer, American
Nurses Association, Marsha Howell Adams, PhD, RN, CNE,
ANEF, President,Beverly Malone, PhD, RN, FAAN, Chief
Executive Officer, National League for Nursing.
______
Prepared Statement of the Trust for America's Health
Trust for America's Health (TFAH), a nonprofit, nonpartisan
organization dedicated to saving lives by working to make disease
prevention a national priority, is pleased for this opportunity to
provide written testimony on the State of public health funding. As
this subcommittee works to develop a fiscal year 2015 Labor, Health &
Human Services, Education and Related Agencies (LHHS) appropriations
bill, I urge you to ensure adequate funding for public health
prevention and preparedness programs at the Centers for Disease Control
and Prevention (CDC) and other public health agencies.
After several years of cuts, Congress included a significant
increase to CDC in the fiscal year 2014 Consolidated Appropriations
Act, and we thank you for recognizing the importance of public health.
Eighty-five percent of the CDC's annual budget flows to your States and
districts in the form of grants and contracts to State and local public
health departments, and community partners, to conduct critical public
health and prevention activities that every American relies on, such as
protecting us from infectious disease by combating healthcare-
associated infections, delivering immunizations, ensuring preparedness,
and conducting nonstop surveillance.
The CDC and its grantees across the country are working to help
give Americans the information they need to adopt the healthy
lifestyles that will reduce the chronic disease burden on our
healthcare system. In 2012, we spent roughly 75 percent of our Nation's
annual $2.8 trillion healthcare bill on treating preventable chronic
diseases. Long-term healthcare spending at these levels is
unsustainable for our economy and our Federal budget.
There is a growing evidence base that demonstrates that the
majority of chronic disease is preventable by addressing common risk
factors. We have begun to see signs of success, with childhood obesity
rates declining in cities and States that were among the first to adopt
a comprehensive approach to obesity prevention. We must bring that
knowledge to scale, so that Americans across the country have the
opportunity to lead healthier lives. We were pleased that last year
Congress made important new investments in community prevention that
will help continue our efforts to transform our healthcare system to
one that values prevention and wellness, and we urge the Committee to
build on those investments in the fiscal year 2015 bill.
The recently released Robert Wood Johnson Foundation 2014 County
Health Rankings serve as another sobering reminder that an American's
zip code is a strong predictor of whether or not they have the
opportunity to lead a healthy life. Meeting these twin challenges of
protecting the American people from natural and man-made threats and
preventing disease can only occur with continued support for CDC.
Centers for Disease Control and Prevention (CDC)
From fiscal year 2010 to 2013, the CDC saw its budget authority cut
by 18 percent. We were pleased that the fiscal year 2014 Omnibus
Appropriations measure provided CDC with an increase of more than $550
million, including $373 million from the Prevention and Public Health
Fund, resulting in a nearly $175 million increase for chronic disease
programs. For perspective, however, that increase simply brought CDC
funding back to fiscal year 2013 levels. Scarce resources means CDC
will be forced to make extremely difficult, sometimes life and death
choices. We urge the Committee to maintain adequate CDC funding levels
in fiscal year 2015.
The Prevention and Public Health Fund (PPHF)
TFAH was pleased to see Congress exercise its authority to allocate
the Prevention and Public Health Fund in fiscal year 2014, and we urge
this committee to do so again in the fiscal year 2015 appropriations
bill. To date, the Fund had made investments in every State to support
State and local efforts to transform and revitalize communities, build
epidemiology and laboratory capacity to track and respond to disease
outbreaks, address healthcare associated infections, train the Nation's
public health and health workforce, prevent the spread of HIV, expand
access to vaccines, reduce tobacco use, and help control the obesity
epidemic.
National Center for Chronic Disease Prevention and Health Promotion
(NCCDPHP)
Our Nation's doctors and hospitals are our trusted front line when
illness appears, but we must continue to engage not only health systems
but sectors such as education, housing, business and planning to
transform communities to make the healthy choice the easy choice and
prevent illness in the first place. The Chronic Disease Center has made
progress in moving away from the traditional categorical approach to
funding disease prevention and toward more coordinated, cross-cutting
strategies. While we were disappointed at the premature termination of
the Community Transformation Grants program, TFAH appreciates the new
investments in community prevention made in fiscal year 2014. We hope
the Committee restores funding for the Chronic Disease Center to fiscal
year 2010 levels ($1.167 billion), building upon fiscal year 2014
investments in diabetes, heart disease and stroke, the Partnerships to
Improve Community Health initiative, the Racial and Ethnic Approaches
to Community Health program and the Preventive Health and Health
Services Block Grant program. For the block grant, TFAH calls upon the
Committee to promote its use to modernize our public health system by
supporting health department accreditation and other efforts to ensure
the Nation's health departments can deliver foundational public health
capabilities to all Americans.
National Center for Environmental Health (NCEH)
Critical programs conducted at the CDC National Center for
Environmental Health support our chronic disease prevention and public
health preparedness efforts. Yet it remains one of the most critically
underfunded parts of CDC. We recommended that you fund NCEH at fiscal
year 2010 levels ($181.004 million) in fiscal year 2015 to continue to
rebuild the lead control program, grow our National Environmental
Public Health Tracking Network, and pursue other priorities.
Public Health Emergency Preparedness Grants
The Public Health Emergency Preparedness (PHEP) Grants,
administered by CDC, is the only Federal program that supports the work
of health departments to prepare for all types of disasters, including
bioterror attacks, natural disasters, and infectious disease outbreaks.
The grants fund nearly 4,000 State and local public health staff
positions, and support 15 core capabilities including public health
laboratory testing, surveillance and epidemiology, community
resilience, countermeasures and mitigation, and more. These funds are
used for everyday preparedness activities, such as monitoring public
health threats, and have been integral in expanding to respond to full-
scale disasters such as Hurricane Sandy, the fungal meningitis
outbreak, and the West Nile Virus outbreak in Texas. TFAH recommends
$670 million for the Public Health Emergency Preparedness Cooperative
Agreements in fiscal year 2015 to help States and localities restore
some of the core capabilities lost due to significant cuts to the
program.
Hospital Preparedness Program
The Hospital Preparedness Program (HPP), administered by the
Assistant Secretary for Preparedness and Response (ASPR), provides
funding and technical assistance to prepare the health system to
respond to and recover from a disaster. The program, which began in
response to 9/11, has evolved from one focused on equipment and
supplies held by individual hospitals in response to a terrorist event,
to a system-wide, all-hazards approach. The new HPP is building the
capacity of healthcare coalitions--regional collaborations between
healthcare organizations, providers, emergency managers, public sector
agencies, and other private partners--to meet the disaster healthcare
needs of communities. Through the coalition planning process,
facilities are learning to leverage resources, such as developing
interoperable communications systems, tracking beds, and writing
contracts to share assets.
HPP helped a prepared healthcare system save lives during recent
events, including the Boston Marathon bombings and tornadoes in
Kentucky and Joplin, MO. HPP appropriations have decreased from $426
million in fiscal year 10 to $255 million in fiscal year 2014,
including a one third cut in the fiscal year 2014 omnibus. TFAH
recommends $300 million for fiscal year 2015 for HPP, an incremental
step to rebuild the program. The significant reduction in fiscal year
14 will likely result in fewer staff, fewer coalitions and less of the
Nation prepared for disasters.
Combatting Prescription Drug Abuse
Prescription drug abuse is a growing public health crisis. Overdose
deaths involving prescription painkillers have quadrupled since 1999
and now outnumber deaths from all illicit drugs, including heroin and
cocaine, combined. This is a multi-faceted problem, and the CDC,
SAMHSA, NIH and a range of other agencies have a role to play in
finding a solution. TFAH recommends a $15.6 million increase to the CDC
Injury Center's Injury Prevention Activities line to enable the CDC to
work with additional States with a high burden of prescription drug
abuse to help address the main drivers of the epidemic of prescription
drug overdoses, and also urge you to provide the funding to ensure that
patients with prescription drug addiction have access to the treatment
they need to turn their lives around.
Conclusion
Investing in disease prevention is the most effective, common-sense
way to improve health and address our long-term deficit. Hundreds of
billions of dollars are spent each year to pay for healthcare services
once patients develop an acute illness, injury, or chronic disease. A
sustained investment in public health and prevention is essential to
reduce high rates of disease and improve health in the United States.
[This statement was submitted by Jeffrey Levi, Executive Director,
Trust for America's Health.]
______
Prepared Statement of Rebecca Underwood, Parent/Guardian/Advocate
Thank you for this opportunity to provide outside witness testimony
for the record to the Senate Appropriations Subcommittee on Labor,
Health and Human Services, Education and Related Agencies. I strongly
object to the use of United States Department of Health and Human
Services (DHHS) appropriations to develop coercive and subversive
methods of deinstitutionalization resulting in the eviction of the most
vulnerable individuals with intellectual/developmental disabilities
from DHHS Medicaid licensed and funded facilities including
intermediate care facilities for individuals with intellectual
disabilities (ICFs/IID). I submit this testimony as a request that
Congress prohibit Federal funds be allocated to Federal programs which
are currently using their public funds to achieve dangerous public
policies of forced deinstitutionalization, resulting in the eviction of
eligible individuals with severe, profound and extreme intellectual and
developmental disabilities (I/DD) from their HHS-licensed and funded
homes, without regard to individual choice.
I am the mother and co-guardian of an adult son, aged 34 who, as
the result of brain and pulmonary hemorrhaging occurring during a
premature birth, functions at the level of a 4-12 week old infant with
chronic and complex medical issues. After providing his 24/7 care in
our home for several years, we accepted the reality that our son would
benefit from the extended care available in a highly specialized
intermediate care facility for individuals with intellectual
disabilities. Our son has benefitted tremendously from the highly
specialized medical services provided in this setting as evidenced by
his continued survival beyond any one's expectations.
Our parenting decisions, our son's continued residence in his
current DHHS funded facility and receipt of the services uniquely
suited to meet his extensive and complex physical and medical needs,
which have proven beneficial for his survival, are under attack. A
number of DHHS funded programs are targeting forced displacement of our
most fragile constituency without regard to individual choice, need and
safety.
Examples of how government dollars, through DHHS appropriations,
are being misused in a cruel and absurd method by DHHS funded programs
and policies to affect the downsizing and closure of DHSS licensed and
funded facilities include:
--Administration on Intellectual and Developmental Disabilities
(AIDD) administers programs and grants created under Public Law
106-402, Developmental Disabilities Assistance and Bill of
Rights Act of 2000 (DD Act). The DD Act was last reauthorized
in 2000. Authorizations for DD Act appropriations expired in
2007; however Congress continues to fund these programs. DD Act
programs, including Protection and Advocacy (P&A) and DD
Councils, operate in every State. AIDD, now under the umbrella
of the Administration for Community Living within DHHS,
administers the DD Act programs. In 2011 AIDD's (f/k/a ADD)
proposed recommendations included ``[d]evelop and implement
plans to close public and private institutions''. There have
been no hearings or recourse for families to address concerns
as to the way in which programs, including AIDD, use/misuse
Federal funds. DHHS has been unresponsive to complaints from
families of persons with severe, profound and extreme forms of
developmental disabilities about AIDD policies. DHHS has turned
a blind eye to the tragic, but predictable, results for many
individuals when they are forced from their specialized,
Medicaid certified and funded congregate care settings.
Independent oversight of Federal AIDD and DD Act programs is
desperately needed. How long will Congress and society continue
to ignore the increasing rate of tragic outcomes due to a
misguided ideological agenda of forced deinstitutionalization
of our most vulnerable citizens from their safe environments?
--National Council on Disability (NCD) is an independent Federal
agency funded through DHHS appropriations. In October 2012 the
NCD released a 110 page policy document and an accompanying 201
page ``tool-kit'' to assist opponents of congregate care to
accomplish the closure of Medicaid-certified specialized homes
of 4 or more beds in which individuals with severe and profound
cognitive and other developmental disabilities receive supports
and services. Families and guardians of these affected
individuals are universally opposed to such closures and are
united in their opposition to NCD's misuse of their authority
as an independent Federal agency and their Federal funding. NCD
has been called upon by these families to reject their stance
on forced deinstitutionalization. The NCD has thus far ignored,
and failed to respond to, the request of these most important
stakeholders. Despite extensive documentation of widespread
abuse in community settings, along with a nationwide crisis of
understaffed, underpaid, and poorly trained direct care workers
resulting in tragic outcomes, the NCD continues pressing
forward with their position that ALL individuals with
intellectual/developmental disabilities, even those who
experience profound and complex medical, physical and/or
behavioral challenges, be forced from their safe homes if that
safe home is 4 or more beds. As an ``independent Federal agency
charged with advising the President, Congress, and other
Federal agencies regarding policies, programs, practices and
procedures that affect people with disabilities'' NCD should
not be taking any position which tramples on the rights of a
portion of the disability community.
--DHHS Incentive grants (increase in FMAP funds) to encourage States
to move away from providing institutional care.
--Money Follows the Person is a Federal ``reward'' for cash
strapped States to move away from providing institutional
care. Money Follows the Person (MFP) grants provide
increased FMAP (Federal Medical Assistance Percentage)
funds to States as a reward for each institutionalized
person in the target population who transitions to an
eligible non-institutional setting. Money Follows the
Person grants ($4 Billion) have been acknowledged to
disproportionately target individuals with developmental
disabilities for transition.\1\ MFP has also been
acknowledged as a way for States to transition individuals
``out the back door'' of institutions while ``closing the
front door'' to new admissions in an effort to close
facilities.
---------------------------------------------------------------------------
\1\ Audra T. Wenzlow and Debra J. Lipson, ``Transitioning Medicaid
Enrollees from Institutions to the Community: Number of People Eligible
and Number of Transitions Targeted Under MFP'', Reports from the Field,
Number 1, January 2009, Mathematica Policy Research,
pg 6, http://www.mathematica-mpr.com/publications/PDFs/health/
MFPfieldrpt1.pdf (accessed 20 March 2014).
---------------------------------------------------------------------------
--Balancing Incentive Program (BIP) is another Federal incentive in
the amount of $3 billion to cash strapped States to divert
eligible individuals from institutional settings,
disregarding choice and need.
Combined total of $7 Billion in Federal funds through these
Incentive grants, in addition to States' regular Federal Medical
Assistance Percentage (FMAP), to encourage States to abandon
institutional settings. Federal funds should not be utilized to favor
one service setting over another, particularly as clarified in the
Supreme Court's Olmstead ruling: ``We emphasize that nothing in the ADA
or its implementing regulations condones termination of institutional
settings for persons unable to handle or benefit from community
settings...Nor is there any Federal requirement that community-based
treatment be imposed on patients who do not desire it.'' Olmstead, 119
S. Ct. 2176, 2187 (1999) (majority).
It will be a travesty if the Federal Government is successful in
pigeon-holing disability policy into a one-size-fits-all, eliminating
choice, while continuing to ignore Supreme Court clarifications within
Olmstead regarding the care of those with the most severe forms of
developmental disabilities. We need an increasing array of viable
options for services and supports for our most vulnerable, not less.
How long will Congress and society continue to ignore the
increasing rate of tragic outcomes (abuse, neglect, unnecessary &
preventable deaths) of a misguided ideological agenda of forced
deinstitutionalization of our most vulnerable citizens from their safe
environments?
In conclusion I call upon Congress to prohibit the Department of
Health and Human Services' use of appropriations for
deinstitutionalization activities that result in the eviction of
eligible individuals with intellectual and other developmental
disabilities from DHHS licensed and funded facilities.
______
Prepared Statement of the United Negro College Fund
Introduction
I am Dr. Beverly Daniel Tatum, President of Spelman College in
Atlanta, Georgia. Founded in 1881, Spelman College is a global leader
in the education of women of African descent and a Historically Black
College. Since 2008 Spelman College has averaged a 6-year graduation
rate of 77 percent--one of the highest of the 105 Historically Black
Colleges and Universities and substantially above the national average
of 59 percent.
Spelman College is one of the 37 private Historically Black
Colleges and Universities (HBCUs) that are members of the United Negro
College Fund (UNCF), which I am representing. UNCF is the Nation's
largest higher education organization serving students of color,
perhaps best known by the iconic motto--``A mind is a terrible thing to
waste.''
In its 70-year history, UNCF has raised more than $4 billion in
scholarship aid to help more than 400,000 students of color attend
HBCUs and 900 other colleges and universities across the country to
obtain the education they need to excel in the 21st century economy.
UNCF's largest scholarship is the Gates Millennium Scholarship offered
to high-achieving, low-income African American, American Indian/Alaska
Native, Asian Pacific Islander and Hispanic American students. UNCF has
awarded $179 million in Gates Millennium Scholarships to help 3,200
students from the States the Labor-Health and Human Services-Education
Subcommittee represents earn college degrees.
HBCU Value Proposition
UNCF's core mission, however, remains its partnership with the
Nation's 37 private HBCUs. The money raised by UNCF has become even
more important today as HBCUs have suffered from a ``perfect storm'' of
Federal disinvestments since 2011. Limitations on Pell Grant
eligibility requirements, sequestration cuts to the Title III HBCU
Program and Parent PLUS Loan reductions have resulted in a loss of more
than $250 million in Federal support. Despite these challenges, HBCUs
provide enormous value for students and the Nation. HBCUs represent
approximately 4 percent of all 4-year colleges and universities; enroll
9 percent of all African American college students; confer 16 percent
of bachelor's degrees awarded to African Americans; and generate 27
percent of the STEM bachelor's degrees awarded to African Americans.
Moreover, HBCUs accomplish this while serving students with greater
need: more than 70 percent of students who attend HBCUs are low-income
students who depend on Federal Pell Grants for their education, a
substantially greater share than the 43 percent of students at all
other 4-year colleges and universities. At the same time, total cost of
attendance at HBCUs is 30 percent lower, on average, than other 4-year
institutions.
Fiscal year 2014 Appropriations
I would like to thank the Subcommittee and, in particular, Chairman
Harkin and Ranking Member Moran for playing leadership roles in
restoring some of the vital Federal resources to HBCUs and the students
we serve in the fiscal year 2014 budget. UNCF appreciates you providing
a maximum Pell award of $5,730, restoring sequestration cuts to other
student aid programs, and restoring two-thirds of the sequestration
cuts to the Title III HBCU Program.
Fiscal year 2015 Appropriations Priorities
Looking to fiscal year 2015, a national strategy to produce more
college graduates, boost our economy and enhance global competitiveness
must include greater investment in HBCUs. On behalf of the UNCF
institutions and all HBCUs, I urge the Subcommittee to support our
highest priority programs listed below:
--I urge you to appropriate $267 million in discretionary dollars and
$85 million in mandatory dollars for the Title III, Part B--
Strengthening Historically Black Colleges and Universities
Program. These are formula funds awarded to HBCUs for
operational support and essential academic services. Let me
note that during the 2007-2012 grant cycle, Spelman College
received and expended more than $11 million in Title III
funding. Spelman has enhanced its campus infrastructure to
include upgrades in technology to facilities, classrooms, labs
and centers. Title III assisted with the establishment of the
SpelBots (Spelman's Robotic Team) a winning robotics
initiative. Additional examples of the achievements that
critical Title III funding has supported at Spelman are
included as an attachment to my testimony. Please reinvest in
this program and restore the $43 million cut from the program
since fiscal year 2010.
--The HBCU Capital Financing Program finances low-risk Federal loans
to help HBCUs, especially private institutions, improve
facilities, infrastructure and technology. Investing in capital
projects not only enhances the educational environment for
students but also reinvigorates our communities and provides
much needed jobs. I urge you to increase the appropriation for
loan subsidies to $25 million, which would leverage $390
million in annual loans to meet the infrastructure needs of our
institutions.
--Without Pell Grants, most HBCU students could not pay for the
college education that is essential in today's economy. I urge
you to fund a $5,830 maximum Pell award to help our students
persist and complete college. In addition, I encourage you to
reinstate ``summer'' Pell Grants so students can earn their
college degrees faster and at a lower cost.
--UNCF also strongly supports the President's fiscal year 2015
request of $75 Million for College Success Grants for Minority-
Serving Institutions. These competitive grants would help
Minority-Serving Institutions launch new innovations and best
practices to improve student outcomes. I urge you to fully fund
this important initiative.
--I urge you to approve the proposed College Opportunity and
Graduation Bonuses, which would reward institutions that enroll
and graduate large numbers of low-income students. UNCF
recommends that this proposal be amended to take into
consideration both the numbers and percentages of low-income
students graduating from institutions, given that some HBCUs
have smaller enrollments.
--Finally, I urge you to restore the Health Professions Training for
Diversity programs to fiscal year 2012 levels and ask that you
expand the National Institute on Minority Health and Health
Disparities to $283 million to improve diversity in the
workforce and research funding for minority populations.
Chairman Harkin and Ranking Member Moran and members of this
Subcommittee--you have the power to increase Federal resources for
operating support, student assistance, best practices and innovations
so that HBCUs can thrive in years to come. Or, you can adhere to the
status quo and allow our institutions to merely survive.
UNCF does not accept the status quo. We are accelerating our
fundraising efforts, investing in capacity building at our member
institutions, building new partnerships and leveraging our resources to
enhance educational opportunities for minority students. In fact, UNCF
has updated its motto to recognize education is an investment in better
futures for everyone. We believe that, ``A mind is a terrible thing to
waste, but a wonderful thing to invest in.'' Please help us invest in
our youth, in our HBCUs, and most importantly, in our country so that
millions more low-income, minority students can graduate from college
and lead our country to heights we have yet to imagine. Thank you for
the opportunity to submit written testimony.
[This statement was submitted by Dr. Beverly Daniel Tatum,
President, Spelman College.]
Attachments:
--HBCU Coalition fiscal year 2015 Appropriations Priorities
--Spelman College Title III Accomplishments
______
Attachments
Historically Black Colleges and Universities
$267 Million Discretionary/$85 Million Mandatory for Strengthening
Historically Black Colleges and Universities Program--Title III, Part
B, supports critical investments in HBCUs such as student academic
services, infrastructure and teacher education programs needed to
enhance educational opportunities for our students. This critical
investment helps HBCUs to continue delivering services to our Nation's
neediest students. The HBCU Coalition respectfully requests $267
million discretionary funding, which would restore this program to its
fiscal year 2010 level, and $85 million mandatory funding for fiscal
year 2015.
$61 Million for Strengthening Historically Black Graduate
Institutions Program--This program provides financial assistance to
Historically Black Graduate Institutions to establish or strengthen
physical buildings and supports graduate students with scholarships and
fellowships. This aid allows the next generation of scientists,
mathematicians and graduate students to complete professional degrees
in underrepresented fields of study. The HBCU Coalition requests $61
million funding, which would restore this program to its fiscal year
2010 funding level.
$11 Million Discretionary/$15 Million Mandatory for Strengthening
Predominantly Black Institutions--This program provides Predominantly
Black Institutions with funds to develop and implement programs to
educate more low-income, African American college and secondary
students. The HBCU Coalition requests $11 million discretionary and $15
million mandatory funding, which would restore this program to its
fiscal year 2010 funding level.
$25 Million for the HBCU Capital Financing Program and Remove the
Loan Guarantee Cap--The HBCU Capital Financing program provides low-
cost capital to finance physical improvements on HBCU campuses by
guaranteeing and administering loans. In fiscal year 2013 and fiscal
year 2014, demand is expected to exceed $800 million. We urge Congress
to increase loan subsidies by $5.5 million to $25 million. This
increase would support $86 million in new loans to approximately 2--8
additional institutions for a total annual loan volume of $390 million.
At a minimum, we recommend restoring the loan subsidy to its pre-
sequester level of $20.5 million. We support the appropriations
language recommended by the Education Department to remove the $1.1
billion loan guarantee statutory cap.
$5,830 for the Pell Grant Maximum Award and Reinstate ``Summer''
Pell Grants--Pell Grants provide low- to moderate- income students with
the financial assistance to go to and through college. The HBCU
Coalition requests funding for the maximum Pell award at its authorized
fiscal year 2015 level (currently estimated by OMB to be $5,830). In
addition, we request reinstatement of the ``summer'' Pell Grant to
allow students to accelerate their paths to graduation and lower their
overall college costs.
$75 Million for College Success Grants for Minority-Serving
Institutions--The President's fiscal year 2015 budget proposes to
initiate new College Success Grants for Minority-Serving Institutions
(MSIs) to assist MSIs in developing sustainable strategies to reduce
costs and improve student outcomes. Funded activities could include
partnering with school districts and schools to provide college
recruitment, awareness, and preparation activities; establishing high-
quality dual-enrollment programs that allow students to earn college
credit while still in high school; providing comprehensive student
support services; and reducing the need for remedial education. The
HBCU Coalition supports the President's request of $75 million for this
program.
$647 Million for a College Opportunity and Graduation Bonus
Program--President Obama's fiscal year 2015 budget proposes a College
Opportunity and Graduation Bonus program that will reward colleges that
successfully enroll and graduate a significant number of low- and
moderate-income students on time. Grants would fund key investments and
best practices such as providing need-based financial aid, enhancing
academic and student supports and other innovative strategies to
improve low-income student outcomes. The HBCU Coalition supports the
President's request but also encourages Congress to modify the proposal
to recognize institutions that enroll and graduate significant numbers
or percentages of Pell-eligible students, accounting for the many HBCUs
that have small enrollments.
$50 Million for a National Five Fifths Agenda for America
Initiative--To support the Administration's My Brother's Keeper
initiative, the HBCU Coalition proposes $50 million for a new program
called the Five Fifths Agenda for America to expand educational
outcomes for African American males. The objective of this program is
to demonstrate how colleges and universities, especially HBCUs, and K-
12 schools can forge partnerships to help African-American males
prepare for, get to and through college by implementing research-based
best practices.
$250 Million Authorization for a HBCU Innovation Fund--To support
the Administration's efforts to drive change in higher education
policies and practices that improves college access, affordability,
completion and quality, the HBCU Coalition proposes that additional
financial resources be provided to HBCUs through an Innovation
initiative under the Higher Education Act. An Innovation Fund would
incentivize HBCUs to address performance goals in certain categories,
such as student retention and completion, STEM, use of technology and
new educational delivery methods that can speed time to degree and
lower costs. All public and private HBCUs, or consortia of these HBCUs,
other institutions and nonprofit organizations, would be eligible to
receive planning and implementation grants.
______
Spelman College
highlights: title iii, part b, sec. 323--strengthening historically
black colleges and universities program
Spelman College is the oldest historically black college for women.
Located in Atlanta, Georgia, Spelman was founded in 1881 as the Atlanta
Baptist Female Seminary. The College maintains a student population of
approximately 2,000 from 45 U.S. States and 13 countries, and since
2008 has had an average 6-year graduation rate of 77 percent.
Title III--Strengthening Historically Black Colleges and
Universities funding plays a critical role in obtaining resources that
provide students and faculty with unparalleled opportunities for
educational enrichment and advancement. In the 2007-2012 grant cycle,
Spelman College expended more than $11 million in Title III funds.
Those resources were expended on a number or projects with wide-ranging
effects on student life, faculty engagement, and facility improvement.
--Title III funding supports and enhances institutional efforts in
four critical areas: Academic Quality, Student Services
Outcomes, Institutional Management and Fiscal Stability. Our
advancements in these key areas are reflected in key indicators
related to enrollment, retention, graduation and fiscal
stability.
--Title III funding undergirds 100 percent of the Foundational
Priorities of the College's Strategic Plan, enhancing academic
rigor in new student orientation, freshman-year and sophomore-
year experiences.
--The College's retention rate is 90 percent. The average 5-year
(2007-2011) second-year retention rate is 87 percent. Title III
funds continue to assist the institution with providing
supportive programs that ensure Spelman's first and second year
students successfully progress to junior status.
--The College's 6-year graduation rate has ranged from a high of 83
percent to a low of 73 percent. The average 6-year (2001-2006)
cohort rate is 77 percent.
--Forty-nine Global STEM students have conducted STEM research abroad
since 2011.
--48 labs and 22 classrooms upgraded with state-of-the-art
technology.
--Between 2008-2012, Spelman had 722 students who were admitted to
and attended graduate or professional degree programs in
disciplines in which African Americans are underrepresented.
Select Examples of Title III Activities that Support our Success
--A campus classroom was transformed into a data analysis hub, with
16 new workstations installed. More than 90 percent of students
reported that their interest in and skills related to data
analysis improved as a result of their work in this facility.
--The College implemented DegreeWorks, an online auditing and
advising system that aids students in proactively creating and
fulfilling their individual academic plans and assists faculty
advisors in providing effective support.
--Spelman's Education Studies Program enlarged its interdisciplinary
course offerings through the addition of a new course entitled
``History and Philosophy of African American Education.''
--Creation and implementation of the Student Success Center, which
provides a centralized location for student support services.
--Spelman's Department of Computer and Information Science (CIS)
achieved international recognition for the accomplishments of
its graduates and for its award-winning robotics initiative.
The SpelBots participated in the NSF Education Technology
Senate showcase in November 2009.
These accomplishments serve as evidence of the important role that
resources from the Strengthening Historically Black Colleges and
Universities program play at Spelman and on HBCU campuses across the
Nation.
______
Prepared Statement of the United Tribes Technical College
For 45 years, United Tribes Technical College (UTTC) has provided
postsecondary career and technical education, job training and family
services to some of the most impoverished, high risk Indian students
from throughout the Nation. We are governed by the five tribes located
wholly or in part in North Dakota. We are not part of the North Dakota
State college system and do not have a tax base or State-appropriated
funds on which to rely. We have consistently had excellent retention
and placement rates and are a fully accredited institution. Section 117
Carl Perkins Act funds represent a significant portion of our operating
budget and provides for our core instructional programs. The request of
the UTTC Board for fiscal year 2015 is:
--$10 million for base funding authorized under Section 117 of the
Carl Perkins Act for the Tribally Controlled Postsecondary
Career and Technical Institutions program (20 U.S.C. Section
2327). This is $2.3 million above the fiscal year 2014 level
and the fiscal year 2013 post-sequestration level. These funds
are awarded competitively and distributed via formula. We are
seeking a change to the formula which is not so reliant on
Indian Student Count in order to avoid dramatic swings in
annual awards.
--Forward Funding. We ask that the Section 117 Perkins funds, like
the other funds under the Carl Perkins Career and Technical
Education Act, be put on a forward funded basis.
--$30 million as requested by the American Indian Higher Education
Consortium for Title III-A (Section 316) of the Higher
Education Act, $5 million above the fiscal year 2014 level.
--Maintain Pell Grants at the $5,830 maximum award level.
We are disappointed that the fiscal year 2014 Appropriations Act
did not restore the fiscal year 2013 Section 117 sequestration even
though funding for the overall Perkins Act was restored. Perhaps
Section 117 was overlooked as a source of job training as it is in the
Higher Education portion of the budget. We all realize the urgent need
to better prepare a workforce to meet industry and other emerging
needs. We are part of that undertaking, but need more resources to come
closer to our potential.
We don't know if Congress will reauthorize the Carl Perkins Act
this session, but point out that the Administration's Blueprint for
Perkins reauthorization specifically states support for the Tribally
Controlled Postsecondary Career and Technical Education program and
includes some national recommendations that UTTC is already
implementing including:
--Training that is industry certified and provision of postsecondary
certificates and degrees.
--Alignment with labor market needs--the ramifications of the North
Dakota Bakken oil boom are seen throughout the State. We saw
the need for more certified welders in relation to the oil boom
and so expanded our certified welding program for these good-
paying, in-demand jobs. Similarly, our online medical
transcription program was designed to meet the growing need for
certified medical support staff. Other courses reflect new
emphasis on energy auditing and GIS Technology.
--Articulation agreements between UTTC and junior and senior high
schools.
--A broad range of services for our students to help ensure their
success.
Additional Information about UTTC. We have:
--Renewed unrestricted accreditation from the North Central
Association of Colleges and Schools for July 2011 through 2021,
with authority to offer all of our full programs on-line. We
have 26 Associate, 20 Certificate and three Bachelor degree
programs.
--Services including a Child Development Center, family literacy
program, wellness center, area transportation, K-8 elementary
school, tutoring, counseling and housing.
--A semester retention rate of 85 percent and a graduate placement
rate of 77 percent. Over 45 percent of our graduates move on to
4-year or advanced degree institutions.
--Students from 75-88 tribes; 85 percent of our undergraduate
students receive Pell Grants.
--An unduplicated count of undergraduate degree-seeking students and
continuing education students of 1391.
--A critical role in the regional economy. Our presence brings at
least $34 million annually to the economy of the Bismarck
region. A 2005 study showed a projected return on Federal
investment of 20-1.
--We have recently opened a distance learning center in Rapid City,
SD, where there are some 16,000 American Indians in the area.
We are also working toward the establishment of an American
Indian Specialized Health Care Training Clinic.
Section 117 Perkins Base Funding. Funds are needed to: 1) maintain
100-year-old education buildings and 50-year-old housing stock for
students; 2) upgrade technology capabilities; 3) provide adequate
salaries for faculty and staff who are in the bottom quartile of salary
for comparable positions elsewhere; and 4) fund program and curriculum
improvements.
Perkins funds are central to the viability of our core
postsecondary education programs. Very little of the other funds we
receive may be used for core career and technical educational programs;
they are competitive, often one-time targeted supplemental funds. Our
Perkins funding provides a base level of support while allowing the
college to compete for desperately needed discretionary funds.
Forward Funding. We ask that the Appropriations Committees provide
one-time funding for Section 117 Perkins to put it on a forward funded
basis. We do not know why it is not already forward funded, given that
the rest of the Perkins is forward funded. A number of years ago
Section 117 was moved to the Higher Education portion of the budget
even though it is authorized through the Perkins Act. Perhaps that has
something to do with it, although we point out that many education
programs are forward funded. Forward funding provides for vital
education programs before the start of each school year, which is
critically important when appropriations are delayed and the Government
is funded via Continuing Resolutions.
Title III-A (Section 316) Strengthening Institutions. Among the
Title III-A statutorily allowable uses is facility construction and
maintenance. We are constantly in need of additional student housing,
including family housing. With the completion of a Science, Math and
Technology building on our South Campus on land acquired with a private
grant, we urgently need housing for up to 150 students, many of whom
have families.
While we have constructed three housing facilities using a variety
of sources in the past 20 years, approximately 50 percent of students
are housed in the 100-year-old buildings of what was Fort Abraham
Lincoln, as well as housing that was donated by the Federal Government
along with the land and Fort buildings in 1973. These buildings require
major rehabilitation. New buildings are actually cheaper than
rehabilitating the old buildings that now house students.
Pell Grants. We support maintaining the Pell Grant maximum to at
least a level of $5,830. This resource makes all the difference in
whether most of our students can attend college.
Government Accountability Office (GAO) Report. As you know, in
March 2011 the GAO issued two reports regarding Federal programs which
may have similar or overlapping services or objectives (GAO-11-318SP of
March 1 and GAO-11-474R of March 18). Funding from the Bureau of Indian
Education (BIE) and the Perkins Act for Tribally Controlled
Postsecondary Career and Technical Institutions were among the programs
listed in the supplemental report of March 18, 2011. The GAO did not
recommend defunding these or other programs; in some cases
consolidation or better coordination of programs was recommended to
save administrative costs. We are not in disagreement about possible
consolidation or coordination of the administration of these funding
sources so long as funds are not reduced.
Perkins funds supplement, but do not duplicate, our BIE funds. It
takes both sources of funding to frugally maintain the institution.
Even these combined sources do not provide the resources necessary to
operate and maintain the college and we actively seeks alternative
funding to assist with curricula, deferred maintenance, and scholarship
assistance. The need for postsecondary career and technical education
in Indian Country is so great and the funding so small, that there is
little chance for duplicative funding. There are only two institutions
targeting American Indian/Alaska Native career and technical education
at the postsecondary level--UTTC and Navajo Technical University.
Combined, these institutions received less than $15 million in fiscal
year 2014 Federal operational funds ($7.7 million from Perkins; $7
million from BIE), a very modest amount for two campus-based
institutions which offer a wide and expanding array of training
opportunities.
* * *
UTTC offers services catered to the needs of our students, many of
whom are first generation college attendees and many of whom come to us
needing remedial education and services. Although BIE and Section 117
Perkins funds do not pay for remedial education, we make this
investment through other sources to ensure our students succeed at the
postsecondary level.
Thank you for your consideration of our requests.
[This statement was submitted by David M. Gipp, Chancellor, United
Tribes Technical College.]
______
Prepared Statement of the University of Kansas Medical Center
Mr. Chairman and Members of the Subcommittee; thank you for the
opportunity to submit this statement regarding fiscal year 2015 funding
for the National Institutes of Health's Institutional Development Award
or ``IDeA'' Program. The IDeA program is funded by NIH's National
Institute of General Medical Sciences (NIGMS), and was authorized by
the 1993 NIH Revitalization Act (Public Law 103-43). I submit this
testimony on behalf of the Coalition of EPSCoR/IDeA States,\1\ the
Kansas IDeA program, and the University of Kansas Medical Center. The
Coalition of EPSCoR/IDeA States respectfully requests that the
Subcommittee provide $310 million for the IDeA program in fiscal year
2015.
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\1\ Alabama, Alaska, Arkansas, Delaware, Guam, Hawaii, Idaho, Iowa,
Kansas, Kentucky, Louisiana, Maine, Mississippi, Missouri, Montana,
Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oklahoma,
Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee,
Utah, Vermont, Virgin Islands, West Virginia, and Wyoming
---------------------------------------------------------------------------
I would first like to provide some basic information about the IDeA
program. The IDeA program increases our Nation's biomedical research
capability by improving research in States that have historically been
less successful in obtaining biomedical research funds. Twenty-three
States and Puerto Rico are eligible. The program funds only merit-
based, peer-reviewed research that meets NIH's biomedical research
objectives. While IDeA was authorized by the 1993 NIH Revitalization
Act (Public Law 103-43), sizable increases in funding only began in
fiscal year 2000. The IDeA program then grew rapidly, due in large part
to the thoughtful actions of this Subcommittee. This initial funding
permitted the launch of two program elements: the COBRE and BRIN/INBRE
programs.
The first was the COBRE program or ``Centers of Biomedical Research
Excellence,'' which are research clusters targeting specific biomedical
research problems. The second IDeA program was BRIN or ``Biomedical
Research Infrastructure Networks,'' which targeted key areas such as
bioinformatics and genomics, and facilitated the development of
cooperative networks between research-intensive universities and
primarily undergraduate colleges. The BRIN grants underwent competitive
renewals in 2004 and were funded under the new name of ``IDeA Networks
of Biomedical Research Excellence,'' or INBRE.
The COBRE program is designed to increase the pool of well-trained
investigators in the IDeA States by expanding research facilities,
equipping laboratories with the latest research equipment, providing
mentoring for promising candidates, and developing research faculty
through support of a targeted multi-disciplinary center, led by an
established, senior investigator with expertise in the research focus
area of the center.
The INBRE program is designed to increase the pipeline of
outstanding students and enhances the quality of science faculty in the
IDeA States by research-intensive networking with undergraduate
institutions. The INBRE program supports research infrastructure and
mentoring of young investigators, and prepares students for graduate
and professional schools as well as careers in the biomedical sciences
at participating institutions. As you can see, these two programs play
complementary roles in developing research capability and human capital
in biomedical fields in the IDeA States.
Impact of the IDeA Program on Kansas
Since the year 2000, Kansas has received more than $190 million in
awards from the IDeA program. Those IDeA investments have enabled our
investigators to secure National Institutes of Health grants and more
than double the amount of funding coming into Kansas. The IDeA program
has resulted in funding of 570 biomedical research grants, supported 71
core biomedical research core facilities, and has resulted in 1,152 new
research related jobs.
The Kansas INBRE (K-INBRE) program consists of three research-
intensive universities and seven primarily undergraduate universities.
Over its 13-year history, the K-INBRE has provided significant benefits
to the State of Kansas, including training a skilled workforce and
helping to drive scientific commercialization potential. Over $45.1
million from the NIH, numerous Kansas Universities, as well as
philanthropies and industry support to the K-INBRE has benefitted
Kansas Universities by significantly aiding Kansas's faculty to
increase NIH funding from $50.3M (2000) to $82.8M (2013). The K-INBRE
has significantly improved in the dissemination of knowledge throughout
Kansas via videoconferencing, symposia and increased intra- and inter-
State collaborations.
The K-INBRE has been successful in establishing the first
bioinformatics facility in Kansas (three campus cores) and been
instrumental in preparing for new advances in increased medical
informatics and translational research. The K-INBRE has also assisted
with building the Kansas biomedical science industry by facilitating
industry collaborations. This is critical, as the growth of the Kansas
bioscience sector is climbing at more than twice the national rate.
Finally, the K-INBRE has contributed to building a skilled
workforce for Kansas by assisting with the building of the biomedical
workforce in Kansas by supporting research training for over 800
undergraduates, numerous post-docs and new faculty investigators.
Importantly, the K-INBRE has helped broaden student research
participation of under-represented groups (rural and ethnic). In 2013
alone, approximately 160 graduate and undergraduate students throughout
the State of Kansas were supported by K-INBRE funds. More importantly,
these funds have broadened research participation by under-represented
rural and ethnic groups, and NIH-level research infrastructure has been
initiated in seven of ten campuses within the K-INBRE network.
Overall, the implementation of the K-INBRE program facilitates the
generation of new strengths in Cell and Developmental Biology in the
State of Kansas, and ultimately contributes importantly to the
development of new tools and strategies for improving human health.
Kansas researchers are currently involved in six active COBRE
awards. Three of these COBREs are located at University of Kansas
Medical Center in Kansas City. The Molecular Regulation of Cell
Development and Differentiation COBRE has established a thriving
multidisciplinary research group focused on the molecular regulation of
cell development. This COBRE has been highly successful in helping
young faculty obtain NIH funding. The purpose of the Nuclear Receptors
in Liver Health and Disease COBRE has been to establish a recognized
center to study liver function in health and disease. This COBRE has
also been very successful at aiding young faculty in obtaining NIH
funding. Importantly, it has also created a valuable ``liver bank''
from many strains of inbred mice. The objective of the Novel Approaches
for Control of Microbial Pathogens COBRE is to promote and enhance the
research capabilities of tenure track junior faculty members of
participating institutions in the State of Kansas with an emphasis on
inhibiting microbial pathogens. This COBRE has been critical in
enabling Kansas faculty to obtain $52 million in NIH funding and has
established a highly utilized flow cytometry core facility at the
University of Kansas Medical Center
The remaining three COBRE programs reside in Lawrence, Kansas at
the University of Kansas. The Center of Biomedical Research Excellence
in Protein Structure and Function conducts important basic research in
health-related protein structure and function. By better understanding
the structure, function, and interaction of proteins present in human
cells, researchers are gaining a deeper understanding of how proteins
carry out critical functions within cells. This COBRE has helped 13
faculty establish independent NIH funding and two faculty supported by
this COBRE have gone on to receive national recognition for their
research.
The Center for Molecular Analysis of Disease Pathways (CMADP) COBRE
brings together junior and senior faculty from the physical,
biological, and pharmaceutical sciences at the University of Kansas and
other academic institutions in Kansas to conduct multidisciplinary
research to develop and implement cutting-edge technologies for
elucidating the genetic, chemical, and physical mechanisms of
biological processes involved in disease. This COBRE has established a
much needed Genome Sequence Core that provides state of the art
sequencing capabilities for researchers in Kansas.
Finally, the Center for Cancer Experimental Therapeutics (CCET)
COBRE brings together researchers from the University of Kansas
Lawrence campus, Kansas State University and the University of Kansas
Medical Center. The Center combines the resources and faculty of
Kansas' institutions to create the infrastructure needed to pursue
cancer-related research and experimentation at the interface between
chemistry and biology. This is the oldest of the COBRE programs in
Kansas and the CCET works to identify novel bioactive compounds that
will be useful basic biomedical research tools and potential
therapeutic agents. Scientists from the participating schools fight
cancer through research projects focusing on specific types of cancer
and the discovery of new anti-cancer drugs and therapies. This COBRE
has established two important research cores associated with medicinal
chemistry and high throughput screening, two key services that are
important for drug discovery. The CCET was also instrumental in
establishing a National Cancer Institute Designated Cancer Center at
the University of Kansas Medical Center in 2012.
Conclusion
Despite these successes, our task is far from complete. Funding
disparities between the States remain and may have a detrimental impact
on our national self-interest. Together, the 23 States and Puerto Rico
that comprise the IDeA community secured just 5 percent of the total
NIH budget in fiscal year 2011. With over 22 percent of the Nation's
population living in the EPSCoR/IDeA States, this figure clearly
indicates the critical need for further research development and the
importance of a strong IDeA program. In fiscal year 1999, the year
before COBRE grants were initiated, the 23 IDeA States and Puerto Rico
received a total of $596 million from NIH. In fiscal year 2013 total
NIH funding to the IDeA community has risen to $1.5 billion. This is
evidence that the program is working and that the IDeA States are
moving in the right direction. To put the value of the IDeA investment
into perspective, the overall fiscal year 2014 IDeA budget, $273.325
million, for 23 States and Puerto Rico, pales in comparison to the
$606.8 million in NIH funding that one institution in one single non-
IDeA State received in fiscal year 2012. In fiscal year 2012, the top
seven States with NIH funding received over a $1 billion each, and
California alone received over $3.5 billion.
We request that this committee recommend the program to be funded
in fiscal year 2015 at $310 million. As you know, the EPSCoR/IDeA
Coalition has maintained that IDeA program should constitute at least 1
percent of the total NIH budget. This level of funding would restore
and continue funding for COBRE and INBRE, provide funding for the IDeA
Program Infrastructure for Clinical and Translational Research (IDeA-
CTR) program, and provide co-funding which would allow researchers and
institutions to merge with the overall national biomedical research
community.
On behalf of the University of Kansas Medical Center, I express
gratitude to this Subcommittee for the efforts it has made over the
years to provide increased funding for IDeA, in particular this
committee's work to ensure the successful inclusion of a $50 million
increase for the program in fiscal year 2012. I hope that you will
continue to invest in this biomedical research program, which is so
important to almost half of the States in the Union. Every region of
the country has talent and expertise to contribute to our Nation's
biomedical research efforts--and every region of the country must
participate if we are to increase our Nation's biomedical research
capacity substantially. On behalf of the EPSCoR/IDeA Coalition, the
University of Kansas Medical Center and our partner institutions across
Kansas, I thank the Subcommittee for the opportunity to submit this
testimony.
[This statement was submitted by Douglas Wright, Ph.D., Professor
and Vice Chair Principal Investigator, Kansas INBRE, Department of
Anatomy and Cell Biology, University of Kansas Medical Center.]
______
Prepared Statement of the University of North Dakota and North Dakota
State University
On behalf of the University of North Dakota and North Dakota State
University, thank you for the opportunity to submit our written
testimony regarding the fiscal year 2015 funding for the National
Institutes of Health (NIH) Institutional Development Award (IDeA)
program. We respectfully request your support of no less than $310.0
million for this critically important program. We further request that
the Subcommittee gives serious consideration to legislative language
which would direct that future NIH budgets include funding for the IDeA
program that reaches no less than 1 percent of the total NIH budget.
IDeA was authorized by the 1993 NIH Revitalization Act (Public Law 103-
43) and funds only merit-based, peer reviewed research that meets NIH
research objectives in the 23 IDeA States and Puerto Rico.
The States eligible for IDeA funding are defined as ``all States/
commonwealths with a success rate for obtaining NIH grant awards of
less than 20 percent over the period of 2001-2005 or received less than
an average of $120 million per year during that time period.''
Currently this includes 23 States and Puerto Rico--nearly half of the
States. Funding from this critical capacity-building program has been a
key part of the growth in research capacity and impact at the two North
Dakota research universities in recent years.
Funding for the IDeA program in fiscal year 2014 was $273.325
million. The total budget for NIH in fiscal year 2014 was $30.2
billion; thus in fiscal year 2014, the IDeA program--funding
competitively awarded biomedical research in nearly half the Nation--
comprised only 0.89 percent of the entire NIH budget. The IDeA program
exists because the 23 eligible States overall receive less than 20
percent of NIH's extramural funding. The President's proposed fiscal
year 2015 budget request of $30.4 billion represents only a 0.7 percent
increase to the NIH, and the proposed increase of $31 million for the
entire National Institute for General Medical Sciences, which houses
the IDeA program is even less, only 0.3 percent. The President's
proposed fiscal year 2015 budget request does not include a recommended
increase for the IDeA program. The IDeA program is designed to aid
small, rural States; it is small in the overall scheme of things at
NIH, but huge for the States that compete for these funds. Our
requested funding level of $310.0 million represents only 1 percent of
the President's total fiscal year 2015 budget request for NIH.
Our State, North Dakota, has benefited immensely from the
competitive funding available through the IDeA program in the form of
COBRE (Center for Biomedical Research Excellence) and INBRE (IDeA
Networks of Biomedical Research Excellence) grants.
At the University of North Dakota, we have been awarded funding for
three phases of a COBRE grant supporting research on neurodegenerative
diseases. North Dakota has one of the largest populations of the
extremely old in the Nation (second only to Rhode Island in the
percentage of its citizens over 85 years of age), and high rates of
neurodegenerative diseases such as Alzheimer's, Parkinson's, and
multiple sclerosis. As an example of the impact of this funding and the
research capacity it has built, externally funded research at the
University of North Dakota's School of Medicine and Health Sciences has
grown substantially. Prior to COBRE funding, in fiscal year 2002, the
SMHS received about $12.0 million in external funding; by fiscal year
2013, this had increased to $27.1 million, an increase of 126 percent.
In 2010, when UND developed a new strategic plan for research,
neuroscience was identified as an existing strength on which to build
further.
Thus, the neurobiology COBRE grant is achieving its intended
purpose of expanding our research capacity and our ability to compete
for Federal funding. That research is directed at problems of direct
interest not only to our citizenry, but also to the rest of the United
States.
The University of North Dakota has also received an additional
COBRE grant on the topic of epigenetics. Epigenetics is the study of
how environmental factors influence the expression of our genes; in
many cases these changes in gene expression can then be inherited by
the next generation. This $12.0 million grant was awarded early in
fiscal year 2014, and will serve to carry out research on environmental
factors that affect disease resistance while developing critical
research capacity in the State.
At North Dakota State University, the Center for Protease Research,
a COBRE supported center, provides fundamental information on how
proteases, key biological players, impact several diseases, including
cancer, arthritis, autoimmune diseases, diabetes, and asthma. These
studies have the potential to provide novel therapeutics that can treat
these deadly and debilitating diseases. The multidisciplinary program
has established two central Core Facilities in biology and synthesis
that have had a significant impact on research programs in the
university and throughout North Dakota. The $24.0 million Center has
initiated several outreach activities such as workshops for North
Dakota University System faculty and students and a summer research
program for undergraduates.
The Center for Visual and Cognitive Neuroscience established in
2004 at North Dakota State University is devoted to increasing our
understanding of the ways that information is perceived and processed
by the brain. Center investigators are involved in the study of visual
and cognitive processing. Core laboratory infrastructure has been
developed allowing faculty and students to fruitfully explore the
relationships between the nervous system and the behavior that it
governs.
Another critically important IDeA program is INBRE, which provides
funding to build the biomedical workforce through activities ranging
from outreach to elementary school children to creating opportunities
for undergraduates to engage in research. This program has provided
support for undergraduate students at 2- and 4-year colleges in North
Dakota to participate in research during the summer at their home
institutions. This program includes two tribal colleges and serves
between 70 and 100 students each year. Another program at the
University of North Dakota serves about 60 undergraduates per year and
applications routinely exceed the number of slots that are available.
These programs are critical for keeping students in the pipeline for
the STEM (science, technology, engineering, and math) workforce.
Studies have repeatedly shown that engaging undergraduates in original
research is a powerful tool for retaining students in college so that
they graduate in a timely way.
A major emphasis has been on outreach programs to Native American
students, the minority group that is most under-represented in the
fields of science, engineering, and math. Between 25 and 35 Native
American students in grades 7-12 participate each year in a program
that uses traditional Native American tools to teach science. As many
as 40 students from tribal colleges are funded each year to visit UND
and learn about opportunities to transfer to the university and
complete their 4-year degrees. INBRE provides support for transfer
students from tribal colleges through the Pathway program, a 6-week
summer program that prepares participants for advanced coursework in
science. Pathway students can also receive tuition waivers from the
university. INBRE funding is also provided to support the American
Indian Health Research Forum on the UND campus each year; this forum
attracts attendees from across the Nation.
North Dakota, with an estimated 2013 population of 723,393, is the
smallest of all the IDeA States. Yet, our School of Medicine and Health
Sciences graduates a disproportionately large number of primary care
physicians who practice in rural areas, and 20 percent of all Native
American physicians in the U.S. are graduates of the University of
North Dakota. The School recently was recognized by the American
Academy of Family Physicians for having the largest percentage of its
graduates enter the field of family medicine of all medical schools in
the United States. The medical school clearly is making important
contributions to healthcare for underserved populations. Like all
medical schools, it must have a healthy research program underpinning
its training of physicians, and funding from the IDeA program is
critical to the health of that program and to building research
capacity for the future.
The IDeA States produce STEM graduates at the same per capita rate
as States with larger populations and larger research portfolios. The
students from IDeA States need and deserve the same exposure to
research as students in larger States. If fiscal year 2015 funding
levels for the IDeA program are not at least maintained at the current
level, and preferably increased to $310.0 million, North Dakota and
other small, mostly rural States, will receive a major setback in their
efforts to increase their capacity to undertake biomedical research and
to train the next generation of scientists who are critical for the
health of our Nation and our economy.
The IDeA program is absolutely critical not only for North Dakota's
two research universities, but also for the biomedical research
capacity and capability of research institutions nationwide. We
sincerely appreciate the Subcommittee's ongoing support of the IDeA
program and request that you give full consideration to our
recommendations and fiscal year 2015 request of no less than $310.0
million for the National Institutes of Health IDeA program. We further
request that the Subcommittee considers legislative language directing
that future NIH budgets include funding for the IDeA program that
reaches no less than 1 percent of the total NIH budget.
______
Prepared Statement of US Hereditary Angioedema Association
summary of fiscal year 2015 recommendations
_______________________________________________________________________
--$32 Billion for the National Institutes of Health (NIH) at an
increase of $1 billion over fiscal year 2014.
--Continued focus on Hereditary Angioedema Research and Education at
NIH
--Funding to create and support the Centers for Disease Control and
Prevention's (CDC) to Increase Awareness Efforts for Hereditary
Angioedema at CDC
_______________________________________________________________________
Thank you for the opportunity to present the views of the US
Hereditary Angioedema Association (US HAEA) regarding the importance of
Hereditary Angioedema (HAE) public awareness activities and research.
The US HAEA is a non-profit patient advocacy organization founded
in 1999 to help those suffering with HAE and their families to live
healthy lives. The Association's goals were, and remain, to provide
patient support, advance HAE research and find a cure. The US HAEA
provides patient services that include referrals to HAE knowledgeable
healthcare providers, disease information and peer-to-peer support. US
HAEA also provides research funding to scientific investigators to
increase the HAE knowledge base and maintains an HAE patient registry
to support ground-breaking research efforts. Additionally, US HAEA
provides disease information materials and hosts forums to educate
patients and their families, healthcare providers, and the general
public on HAE.
HAE is a rare and potentially life-threatening inherited disease
with symptoms of severe, recurring, debilitating attacks of edema
(swelling). HAE patients have a defect in the gene that controls a
blood protein called C1-inhibitor, so it is also more specifically
referred to as C1-inhibitor deficiency. This genetic defect results in
production of either inadequate or nonfunctioning C1-inhibitor protein.
Because the defective C1-inhibitor does not adequately perform its
regulatory function, a biochemical imbalance can occur and produce an
unwanted peptide--called bradykinin--that induces the capillaries to
release fluids into surrounding tissues, thereby causing swelling.
People with HAE experience attacks of severe swelling that affect
various body parts including the hands, feet, face, airway (throat) and
intestinal wall. Swelling of the throat is the most life-threatening
aspect of HAE, because the airway can close and cause death by
suffocation. Studies reveal that more than 50 percent of patients will
experience at least one throat attack in their lifetime.
HAE swelling is disfiguring, extremely painful and debilitating.
Attacks of abdominal swelling involve severe and excruciating pain,
vomiting, and diarrhea. Because abdominal attacks mimic a surgical
emergency, approximately one third of patients with undiagnosed HAE
undergo unnecessary surgery. Untreated, an average HAE attack lasts
between 24 and 72 hours, but some attacks may last longer and be
accompanied by prolonged fatigue.
The majority of HAE patients experience their first attack during
childhood or adolescence. Most attacks occur spontaneously with no
apparent reason, but anxiety, stress, minor trauma, medical, surgical,
and dental procedures, and illnesses such as colds and flu have been
cited as common triggers. ACE Inhibitors (a blood pressure control
medication) and estrogen-derived medications (birth control pills and
hormone replacement drugs) have also been shown to exacerbate HAE
attacks.
HAE's genetic defect can be passed on in families. A child has a 50
percent chance of inheriting the disease from a parent with HAE.
However, the absence of family history does not rule out the HAE
diagnosis; scientists report that as many as 25 percent of HAE cases
today result from patients who had a spontaneous mutation of the C1-
inhibitor gene at conception. These patients can also pass the
defective gene to their offspring. Worldwide, it is estimated that this
condition affects between 1 in 10,000 and 1 in 30,000 people.
public awareness at the centers for disease control and prevention
HAE patients often suffer for many years and may be subject to
unnecessary medical procedures and surgery prior to receiving an
accurate diagnosis. Raising awareness about HAE among healthcare
providers and the general public will help reduce delays in diagnosis
and limit the amount of time that patients must spend without treatment
for a condition that could, at any moment, end their lives.
Once diagnosed, many individuals are able to piece together a
family history of mysterious deaths and episodes of swelling that
previously had no name. In some families, over many years, this
condition has come to be accepted as something that must simply be
endured. Increased public awareness is crucial so that these patients
understand that HAE often requires emergency treatment and disabling
attacks no longer need to be passively accepted. While HAE cannot yet
be cured, intelligent use of available treatments can help patients
lead a productive life.
In order to prevent deaths, eliminate unnecessary surgeries, and
improve patients' quality of life, it is critical that CDC pursue
programs to educate the public and medical professionals about HAE in
fiscal year 2015.
research through the national institutes of health
In years past, HAE research was conducted at the National
Institutes of Health (NIH) through the National Institute of Allergy
and Infectious Diseases, the National Institute of Neurological
Disorders and Stroke, the National Heart Lung and Blood Institute, the
National Institute of Child Health and Human Development, National
Center for Research Resources, and the National Institute on Diabetes
and Digestive and Kidney Diseases. However, NIH has not engaged in HAE-
specific research since 2009, and there is no longer any Federal
research as it relates to HAE.
As it may provide greater opportunities for HAE research, we
applaud the recent establishment of the National Center for Advancing
Translational Sciences (NCATS) at NIH. Housing translational research
activities at a single Center at NIH will allow these programs to
achieve new levels of success. Initiatives like the Cures Acceleration
Network are critical to overhauling the translational research process
and overcoming the challenges that plague treatment development. In
addition, new efforts like taking the lead on drug repurposing have the
potential to speed access to new treatments, particularly to patients
who struggle with rare or neglected diseases. As a rare disease
community, HAE patients may also benefit from the Therapeutics for Rare
and Neglected Diseases (TRND) program, housed at NCATS, as well
coordination with the Office of Rare Diseases Research (ORDR). We ask
that you support NCATS and provide adequate resources for the Center in
fiscal year 2014.
In order to reinvigorate HAE research at NIH, it is vital that NIH
receive increased support in fiscal year 2015. US HAEA recommends an
overall funding level of $32 billion for NIH in fiscal year 2015 and
the inclusion of recommendations emphasizing the importance of HAE
research to learn more about this rare disease and new pathways for
appropriate treatment.
Thank you for the opportunity to present the views of the HAE
community.
[This statement was submitted by Janet Long, Executive Vice
President, US Hereditary Angioedema Association.]
______
Prepared Statement of VOR
I. Introduction
VOR is a national organization that advocates for high quality care
and human rights for all people with intellectual and developmental
disabilities (I/DD). VOR calls on the U.S. Senate to prohibit the use
of U.S. Department of Health and Human Services' (HHS) appropriations
in support of deinstitutionalization activities which evict eligible
individuals with I/DD from their HHS-licensed and funded Medicaid
homes, in violation of Federal law.
Deinstitutionalization activities, including advocacy, lobbying,
class action lawsuits, and other tactics by some HHS-funded agencies
(discussed below) resulting in the downsizing and closure of HHS-
licensed homes are a cruel and absurd use of Federal funding. These
closures often lead to human tragedy. Medicaid-licensed facility homes,
including Intermediate Care Facilities for Individuals with
Intellectual Disabilities (ICFs/IID) and other specialized nursing
facilities, are uniquely suited to meet the residents' profound
support, healthcare and behavioral needs. Tragedies are widespread and
predictable when fragile citizens are removed from specialized care.
The legally-protected rights of families and legal guardians to serve
as primary decision-makers are routinely ignored.
II. Using HHS Funds to Eliminate HHS-Supported Homes: The
Administration on Intellectual and Developmental Disabilities
(AIDD) and its State-based Developmental Disabilities
Assistance and Bill of Rights Act (DD Act) Programs
It has been 14 years since Congress last reauthorized the DD Act.
Authorizations for DD Act appropriations expired in 2007; however,
Congress continues to fund these programs. DD Act programs, including
Protection & Advocacy (P&A), DD Councils, and University Programs,
operate in every State. AIDD, within HHS, administers the DD Act
programs.
Independent oversight of Federal AIDD and DD Act programs is nearly
non-existent.\1\ DD Act programs are using their public funds to
achieve dangerous deinstitutionalization, evicting vulnerable people
with I/DD from Medicaid-certified homes, disregarding individual choice
and the legal right to appropriate services, as required by the
Americans With Disabilities Act (ADA) (as interpreted by the Olmstead
decision) and Medicaid law, both discussed below.
---------------------------------------------------------------------------
\1\ See, VOR Federal Comments Urging Objective Performance--Not
More Self-Reporting--of DD Act Programs (January 25, 2012) (vor.net/
images/VORCommentDDActEvaluation
Jan2012.pdf).
---------------------------------------------------------------------------
The DD Act programs' own authorizing statute supports residential
choice and recognizes that individuals and their families are in the
best position to make care decisions:
``Individuals with developmental disabilities and their families
are the primary decisionmakers regarding the services and
supports such individuals and their families receive, including
regarding choosing where the individuals live from available
options, and play decisionmaking roles in policies and programs
that affect the lives of such individuals and their families.''
DD Act, 42 U.S.C. 15001(c)(3)(2000); see also, H. Rep. 103-442
(March 21, 1994) (``[T]he goals expressed in this Act to
promote the greatest possible integration and independence for
some individuals with developmental disabilities may not be
read as a Federal policy supporting the closure of residential
institutions'').
Yet, AIDD persists in its support for DD Act programs'
deinstitutionalization activities and even proposed a recommendation to
``[d]evelop and implement plans to close public and private
institutions,'' and ``[k]eep people with disabilities out of congregate
institutions,'' in collaboration with DOJ and The Arc (2011). Hundreds
of families and others objected; the recommendation has not yet been
finalized. Likewise, the national organizations for the three DD Act
programs have referred to families who select HHS-licensed homes (ICFs/
IID) as ``clueless'' and ``unaware,'' \2\ a view not shared by the
Supreme Court (see, Heller v. Doe, 509 U.S. 312, 329 (1993) (``. . .
close relatives and guardians, both of whom likely have intimate
knowledge of a mentally retarded person's abilities and experiences,
have valuable insights which should be considered during the
involuntary commitment process.'')).
---------------------------------------------------------------------------
\2\ June 14, 2010 and July 30, 2007 letters to Congress referring
to families as ``unaware'' and ``clueless,'' respectively.
---------------------------------------------------------------------------
With AIDD directive, State-level DD Act program
deinstitutionalization activities continue, exacting great harm on the
very people Congress entrusted these HHS-entities to protect. Since
1996, more than fifteen (15) P&A class action lawsuits for closure (not
relating to conditions of care) and other deinstitutionalization
tactics have been pursued over the objection of residents and their
families. The P&A class action lawsuits are a particularly egregious
use of Federal funds; they equate HHS suing itself because the targets
of these HHS-funded lawsuits are HHS/Medicaid-licensed ICFs/IID.
AIDD and its State-based programs persist in their ideological
devotion to community placement despite reports of 1,200 ``unnatural
and unknown'' deaths in New York, a risk of mortality in community
settings of up to 88 percent in California, more than 100 deaths in
Connecticut, 53 deaths in Illinois, 114 deaths in the District of
Columbia, plus many more reports of abuse, neglect and death across the
majority of all States (see e.g, Widespread Abuse, Neglect and Death in
Small Settings Serving People with Intellectual Disabilities (VOR,
2014)).
III. Using HHS Funds to Eliminate HHS-Supported Homes: National Council
on Disability
The National Council on Disability (NCD) is an HHS-funded,
independent Federal agency that advises the President, Congress, and
other Federal agencies on issues affecting people with disabilities.
On October 23, 2012, NCD released a 300-page policy paper and
related toolkit calling for the closure of residential homes for people
with I/DD, arbitrarily targeting residential homes for four or more
people. NCD spent nearly $150,000 in Federal funds to prepare and
publish ``Deinstitutionalization: Unfinished Business,'' calling on the
broader advocacy community to engage in advocacy efforts and lawsuits
to evict people with I/DD from their homes. NCD did not consult with
the individuals who could be evicted from their homes, nor their
families and legal guardians. Instead, NCD accuses these caring
families and guardians of violating their family members' civil rights
for choosing a care setting of four or more people. NCD has since
received more than 350 letters from families opposing forced
deinstitutionalization.
Like AAID, NCD cites the landmark Supreme Court decision of
Olmstead v L.C. (1999) as justification for its position to close HHS
homes. Like many organizations that support deinstitutionalization,
AAID and NCD misread and misapply the Olmstead decision's requirements.
The Supreme Court is clear in its holding that the ADA requires
individual choice before community placement can be imposed and
recognizes the need for specialized care:
``We emphasize that nothing in the ADA or its implementing
regulations condones termination of institutional settings for
persons unable to handle or benefit from community
settings...Nor is there any Federal requirement that community-
based treatment be imposed on patients who do not desire it.''
Olmstead, 119 S. Ct. 2176, 2187 (1999) (majority).
``As already observed [by the majority], the ADA is not
reasonably read to impel States to phase out institutions,
placing patients in need of close care at risk ...`Each
disabled person is entitled to treatment in the most integrated
setting possible for that person--recognizing on a case-by-case
basis, that setting may be an institution'[quoting VOR's Amici
Curiae brief].'' Id. at 2189 (plurality).
Likewise, Medicaid law and regulation requires that ICF/IID
residents be ``[g]iven the choice of either institutional or home and
community-based services.'' 42 C.F.R. Sec. 441.302(d)(2); see also, 42
U.S.C. Sec. 1396n(c)(2)(C) and 42 C.F.R. Sec. 441.303.
NCD's support for deinstitutionalization is contrary to Federal law
and reckless. ICFs/IID have an array of services not often available
elsewhere (e.g., on-site medical care, dental care, other specialties,
and involvement in their broader communities). As discussed above,
tragedies are predictable when residents are separated from life-
sustaining supports.
IV. Solution and Conclusion
HHS-funded agencies should not be allowed to advance an ideological
agenda in support of evicting eligible people from HHS-licensed homes,
contrary to the DD Act, Medicaid law, and the ADA/Olmstead. Such
actions are a cruel and absurd use of Federal funding that is exacting
great harm on our nation's most vulnerable citizens, and contrary to
societal values which respect individual and family decisionmaking.
Please support language to prohibit the use of HHS appropriations
in support of deinstitutionalization activities which evict eligible
individuals with I/DD from HHS-licensed and funded homes. No Federal
agency should define ``choice'' so narrowly and illegally as to
disenfranchise the most vulnerable segment of our disabled population.
______
Prepared Statement of the Workforce Data Quality Campaign
Workforce Data Quality Campaign (WDQC)--a nonprofit initiative that
advocates for inclusive, aligned and market-relevant data systems--
urges Congress to support programs that provide crucial data needed to
ensure that our Nation is educating its students and workers to succeed
in the 21st century economy.
Federal investments in State data systems, labor market information
and statistical programs have real impacts for:
--Students and workers trying to figure out which colleges and
training programs are best at helping people land a job,
continue their studies or advance in the labor market.
--Policymakers who need to know whether education and workforce
programs are preparing people for good jobs.
--Business leaders wondering whether education and training programs
are preparing enough prospective employees to meet their
companies' needs.
--Educators who want to know the long-term education and employment
outcomes of their graduates, so they can continually improve
their courses and curricula.
Despite their profound impact on education and workforce
development, a number of data-related programs and services have faced
stagnant or declining funding in recent years. As Congress deliberates
on fiscal year 2015 appropriations, we recommend halting this downward
trend and increasing funding for the following programs.
State longitudinal data system grants.--The State Longitudinal Data
System grants provided by the Department of Education (ED) and the
Workforce Data Quality Initiative grants from Department of Labor (DOL)
have propelled the successful development, implementation and expansion
of longitudinal data systems. Continued Federal support will
incentivize the State interagency cooperation necessary to build and
utilize systems that can hold education and workforce programs
accountable for their results. Funding for these grants has been
decreasing over the past several years, gradually eroding this
important source of support for State data systems. The last grant
competition was in fiscal year 2012. Additional funding is important to
help more States improve their data infrastructure and conduct a new
grant competition that focuses States on using data to improve policy
and practice, as well as incorporating longitudinal data from
postsecondary and workforce programs into their systems to allow more
analysis of varied education and career pathways.
Recommendation.--Double the fiscal year 2014 funding level, as
requested by the President's Budget, to support about 20 grants and
national activities designed to promote data coordination, quality, and
use. Include report language directing ED and DOL to collaborate on
providing technical assistance to grantees to ensure inclusive and
aligned data systems.
Workforce Information Grants/Electronic Tools. DOL awards grants to
help States conduct research on local and regional labor markets,
including shifts in industrial and occupational demand and its impact
on the skills needed by the workforce. This information is critical to
align education and training programs with employer needs, and help the
workforce system guide students and workers to programs that will
prepare them for high-demand occupations. Funding for these grants--
included in the Workforce Information/Electronic Tools/System Building
line item in the State Unemployment Insurance and Employment Service
Operations Account--has not increased for over a decade, even as demand
for labor market information has grown. This line item also funds
important national data activities, including the dissemination of
information on different types of credentials and O*NET, which collects
and disseminates information about occupations including associated
skills, knowledge and abilities. O*NET is used as the foundation for
variety of tools to help workers explore careers, such as a new Skills
to Work tool from Texas that helps veterans translate their military
experience into skills appropriate for civilian resumes and match their
skills to job openings.
Recommendation.--Increase funding by $10 million to support an $8
million increase in grants to States and a $2 million increase for
O*NET.
National Center for Education Statistics. This office at ED
provides a number of important services, including labor market-
relevant data products and tools on secondary and postsecondary
enrollments, completions and credential attainment.
Recommendation.--Increase funding to match fiscal year 2012 (pre-
sequester) levels.
Bureau of Labor Statistics. This DOL agency produces an array of
important data, including employment and unemployment of individuals,
jobs and earnings by industry and occupation, job openings and labor
turnover, mass layoffs and occupational projections. As the Nation
continues to face high unemployment, this data is vital to help align
human capital policies with the needs of employers.
Recommendation.--Increase funding by $23 million to support the
following efforts.
--Restore Current Employment Survey funding to 2010 levels (+$7
million) to provide resources to enhance data quality and
reduce employer response burden by encouraging businesses to
voluntarily provide information through electronic data
interchange. This survey is used by local leaders to provide a
near real-time summary of employment conditions and to rapidly
spot key trends in major industries.
--Expand Current Population Survey supplements (+$4 million), which
monitor labor market changes that can help State and local
leaders understand the education and training needs in their
communities.
--Develop new cost-effective approaches for Occupational Employment
Statistics and the National Compensation Survey (+$2 million)
that allow data users to see occupational trends over time by
locality.
--Increase funding for cooperative agreements with States (+$10
million) to enable State partners to produce a variety of labor
market information that is critical for workers, educators and
employers. Funding for these agreements has not risen in over a
decade.
SUMMARY OF RECOMMENDED INCREASES
[Dollars in thousands]
------------------------------------------------------------------------
2014 2015
Department of Labor Enacted Recommendation Increase
------------------------------------------------------------------------
Workforce Data Quality 6,000 6,463 463
Initiative...................
Workforce Information/E-Tools/ 60,153 70,153 10,000
System Building..............
Bureau of Labor Statistics.... 592,212 615,212 23,000
Total Increase............ ........... .............. 33,463
Department of Education--
Institute of Education
Sciences
Statewide Longitudinal Data 34,539 70,000 35,461
Systems......................
Statistics.................... 103,060 108,748 5,688
Total Increase............ ........... .............. 41,149
------------------------------------------------------------------------
Thank you for the opportunity to comment.
[This statement was submitted by Rachel Zinn, Director, Workforce
Data Quality Campaign.]
______